Improving mental health outcomes for young people: the perspective of a GP trainee

During my first few weeks as a GP trainee, I met a young lady who had recently been diagnosed with a serious, long-term condition. Walking into the consultation room, she sat down with her fringe partially covering her eyes. I started by asking her how she had been since her last visit. Slowly, she began telling me how her diagnosis had made her feel.

Fifteen minutes into the consultation, she grew more at ease. She revealed that she had become increasingly low and was finding it difficult to sleep. She was now considering dropping a class that she loved. Her antidepressants, it seemed, had not done the trick.

At the end of our 30-minute slot, together we made a plan to organise counselling. That evening, I contacted her specialist nurse, completed a referral to the psychologist and booked a follow-up consultation. As I finished off my paperwork, one thought lingered: as a new GP trainee, my appointments are 30 minutes long; in a few short months they'll be down to just 10. What would we have achieved in 10 minutes?*

In March 2015, Norman Lamb MP launched Future in mind at The King’s Fund, and the government committed to spending an extra £1.25 billion on children and adolescent mental health services (CAMHS). Six months later, the Fund held an event in partnership with the charity YoungMinds to look at how local areas are planning to transform their services.

Future in mind sets out a strong economic argument for improving the emotional health and wellbeing of young people: 75 per cent of adult mental health problems start before the age of 18. It also highlighted the current set of challenges, which include: difficulties in accessing services; crisis assessment; and issues specifically affecting vulnerable groups. A key theme from our recent conference was the need for better collaboration between agencies. Alison O’Sullivan, President of the Association of Directors of Children’s Services, emphasised the need for a change in how care is delivered – moving away from a system defined in terms of services provided (the ‘tiered’ model) towards one built around the needs of young people and their families.

One of the most striking things about the conference, and indeed this area of policy development, is the extent to which the voices of children and young people are such an integral part of the conversation. JK Rowling once wrote: 'Youth cannot know how age thinks and feels. But old men are guilty if they forget what it was to be young.'

Experts by experience Annie Hart and Aaliyah Esat made a plea at the conference. They asked that all professionals work in partnership with them and treat them as whole people, considering physical and mental health together. They didn’t want to feel stigmatised. They wanted GPs, health visitors and teachers to know what to do if they were worried about a young person or their family. They wanted the people who fund and provide services to be dedicated to offering the best mental health services possible and to be transparent about how they are doing this.

As a GP in training, I know how essential it is that professionals embrace collaborative attitudes to drive change and also receive support for their role in this process. To the young people who might one day use our services, I would say this: I hope that when we meet you, we can make you feel comfortable enough to express how you really feel. I hope that we can listen to you and show you the compassion that you deserve. I hope that we have the right knowledge and time to work with you throughout your journey. I hope that we can offer you and your family a range of services that are both accessible and dedicated. If we meet you in a crisis, I hope that we can get you the help that you need straight away.

Crucially, I hope that our training and the system that we work within will support professionals to do these things to the best of our ability. Specifically, we need the education and we need the encouragement to support us to change the culture of practice.

Young people, and their families, are extremely able to express what they need – and have done so clearly. It is now imperative that providers and commissioners work together to meet those needs, building on the momentum of Future in mind. I’d like to say again to all young people: we hear your voice and we're fighting your corner. Let's fuel this transformation together.

* Details have been removed or amended from the included case to ensure anonymity.

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#545081 Dr Vidya Das
General practitioner

It is very well written ; significant points were raised- for patients with mental health and for trainees
- well done

#545082 Pearl Baker
independent Mental Health Advocate and Advisor/Carer

WBC have cut service to all vulnerable groups, including Mental Health, so where do we go from here?

We must thing about 'innovation' and look at other ways of supporting these groups, and 'monitoring' the services 'supposed' to be offering 'good health and social care'

I have just put together a 'paper' on how we can reduce GP time, while at the same time helping the patient! The Pharmacist can do more and in my paper I show how. It has been well received by a Pharmacist and GP.

My next paper has been on the OPG responsibilities 'monitoring' of those subject to a 'Property and Finance' Order and section 117 of the MHA, including how the LA/Corporate Deputy operate 'outside' the LAW? It covers the problem of Safeguarding'. Housing Association' responsibility under 'Safeguarding' and the LA responsibility to 'Safeguard' those placed into un-regulated accommodation, contracting out to Private Management Companies to Provide care and support. My research show and that of Healthwatch England confirm there are serious concerns brought about by insufficient 'monitoring' of the Housing Association providing 'Supported Living' and the LA failure to 'Monitor' their contracted Management Company, under the CQF, and the LA Deputy failure to implement the LAW.

Housing Association should 'step up' to the mark and start understanding their Tenants rights! however this should be a collaborative approach with the LA. Example if you are under a 'Guardianship' order and placed into Housing Association accommodation it is the LA responsibility to 'pay the rent'. Lots to learn.

#545086 Amit Mohan
NHS Recruitment Consultant
Woodrow Mercer

Hi Preety,

Well written article here. On a side note, it was good to meet with you at the conference focusing on improving children and young people's mental health at the King's Fund a few weeks back.

#545088 Zoe Mulliez
Policy Advisor
Healthwatch England

Hi Preety,

Many thanks for this very interesting and well written article.

We definitely have to make sure children, young people and their families are engaged with suggested changes to local services and to encourage an increase where this is needed. I am personally working on this and I feel passionate about it.

#545092 Hoon

Decent article. Good read. Well done.

#545107 John Kapp

Mindfulness Based Cognitive Therapy (MBCT) 8 week courses are the solution to improving mental health of children and adults, as they are 100 times more cost effective than 1 to 1 CBT, They should be provided in Community Care Centres, and financed out of the prescribing budget and Better Care Fund, see my campaign 'medication to meditation. on papers iin sectcion 9 of

#545115 debbie

I think yoga on perscription should seriously be considered or taught early to someone before stress gets out of hand either later in life or as a tool people can draw upon. or, other types of techniques. their are some very good yoga tutors out there , you don't need a mental health professional for and long term treatment also fun.

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