By Dr Andrew Buist
THIS has been a year like no other. It’s fair to say none of us expected this when 2020 began We had no idea what lay ahead of us – and now almost 12 months later , things are looking up with the development of a vaccine for Covid-19, but this is not over yet, and even when the virus is under control we will be dealing with the after-effects for some considerable time.
We’ve changed the way we work: GPs and hospital clinicians are carrying out more telephone and video consultations than ever before in order to reduce footfall, and decrease the risk of Covid-19 spreading through GP practices and hospitals. Virtual meetings and conferences are the norm – indeed tomorrow’s Scottish Local Medical Committee Conference will take place online for the first time.
The public has been through a lot in 2020 – emotions have been running high: first there was fear, then there was gratitude, and more recently frustration, anxiety, and for some low moods, and even anger. Of late there has been cautious joy at the prospect of a vaccine. But people are dealing with a lot: they want their NHS back to normal after a year of further delays and not being able to see their GP or hospital specialist in the same way or as often as they had in the past – on a face-to-face basis, at least.
For many lockdown proved to be extremely difficult. Not being able to see family and friends outside of your own household – for those who live alone this was even more isolating – working from home and not seeing your colleagues regularly, perhaps having to balance working with childcare commitments. All of that, combined with the fear of Covid and the frustrations it brought, can have a very detrimental impact on an individual’s mental health.
This is one of the key things I will highlight in my speech to my fellow GPs tomorrow. The task of handling the rise in mental health problems at this time falls almost entirely on general practice. This may come as a surprise, but the increase in anxiety and depression that many people are experiencing will not pass the “severe and enduring test’’ Scotland’s mental health services currently set – and as such, GPs know all too well that these referrals will nearly always be rejected.
While GPs are highly skilled in doing everything they can to help their patients who are presenting with mental health problems, they are limited by how long they can spend with a patient who needs longer than a normal consultation to talk through everything that is going on in their lives. And as expert generalists and not mental health specialists, we are limited in the treatments we can offer. This underlines once again why we desperately need to improve how mental health care is provided in Scotland.
Patients need services to be more readily accessible to them – with more mental health workers based in the community, in general practice and local health centres, who are ready to see and listen to distressed patients promptly before harm is done and without a complex referral process . I understand the pressures our health service is under – of course I do – but we simply cannot afford to let the mental health of our nation suffer because it isn’t “severe” enough at the first referral. We have a duty of care and more needs to be done.
Dr Andrew Buist is chair of BMA Scotland’s GP Committee
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