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Teenagers consulting with their GP & practice nurses. Dr Maryanne Freer 07960718764 Maryanne.freer@pcpartners.org. A problem shared is a problem halved. Introductions- myself. Thanks to:. Sir Mark and Lady Rachel Waller- CWMT. Dr Dick Churchill - RCGP Adolescent Task Group
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Teenagers consulting with their GP & practice nurses Dr Maryanne Freer 07960718764 Maryanne.freer@pcpartners.org Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
A problem shared is a problem halved Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Introductions- myself Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Thanks to: Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org Sir Mark and Lady Rachel Waller- CWMT. Dr Dick Churchill - RCGP Adolescent Task Group Dr David Shiers-GP& NIMHE Professor John Spencer & MiC GP tutors- Newcastle Medical School Primary Care Dept Dr Alison Macdonald- Northumbria VTS Director Dr Nicki Williams & Dr Chris Marr – RCGP WBA Professor Chris Drinkwater
v Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Quick quiz Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org Who is the young person’s most favoured health professional & 2 reasons why? How many young people who see a GP have a diagnosable mental health problem?
Quick quiz Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org How many minutes of a GP consultation is spent on a teenagers mental health? Prior to a young person’s suicide do the number of GP consultations increase or decrease?
The job of the “favoured” family doctor & practice team Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org • The confidante • Continuity • Cradle to grave • Through physical health management • Family practice • Mum/Dad • Siblings • Early detection & recognition • Urgents/crisis/ out of hours
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org • Young people see GP’s voluntarily & through their own necessity. E.g contraception needs • GP take a pragmatic, functional approach
Further information: Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org Freer M, Shiers D, Churchill C. Meeting the Mental Health Needs of Young People: A GP's perspective In: I Goldie (Ed) Public Mental Health: A handbook. 2010. Brighton: Pavilion.
Why 10 minutes? Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
No mean feat……. Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Monday morning surgery Psychological or physical? --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Tom, 16 – acne ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Philippa, 36 – crying – mum died suddenly 3 weeks ago ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Harold, 57 – indigestion and lack of energy ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Mary, 84 – cannot swallow and losing weight ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Rob, 27 – recently diagnosed with schizophrenia – drooling asking if this is a side-effect of new meds --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Helen, 14 – tired all the time, irritable and sleepless ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Roger, 20 – diabetic 4 years – poor diabetic control ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Donald, 29 – sick note + pain-killers for back pain after RTA ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Parva, 4 – regularly attends: yet another cough and cold ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Freda, 77 – depressed, early morning waking, no motivation
What GP’s have to know- the “generalist” Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org ESSENTIAL SERVICES; Coronary Vascular Disease , Stroke, Cancer, Diabetes, Hypertension, Mental Health, Asthma, Chronic Obstructive Pulmonary Disease, Epilepsy, Cervical Screening, Child Health Surveillance, Maternity Services, Contraception. ENHANCED SERVICES…
GP’s main concerns - teenage mental health consultation Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org • “ Am I missing some thing ? Is this normal or a diagnosable problem?” • “What to do if teenager referred with long wait times and comes back to me with mum saying “do something?” • “Will I know if….self harming, suicidal ..what to do? ” • “ If no cbt, do I prescribe?” GP case- OC
The GP * practice nurse consultation Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
Zoe Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org Zoe Craddock is 15 and brought into see the GP with a sore throat by her mother. Zoe has been having these sore throats for at least 6 months now. She isn’t very happy at home; she seems to get ill very often, and has to have time off school. Her mum isn’t very sympathetic
What tasks do you see the GP perform? Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
Tasks within the GP& practice nurse consultation Initial consultation Second consultation Mental Health Summary Diagnosis Risk Self help - problem Solving MH Promotion check list • Confidentiality • Rapport building • Dealing with parents • Opportunistic screening question
Consultation issues Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org • Primary care probabilities • Watchful waiting • Clinical un certainity • Management of physical co-morbidity • Safety netting • Use of continuity & follow up • Concordance
What support do GP’s & practice teams need to mean more young people get the help they require? Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Do you know your GP’s? Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org Resources Consultation approaches Education
GP * practice team education Initial consultation Second consultation Mental Health Summary Diagnosis Risk Self help - problem Solving MH Promotion check list • Confidentiality • Rapport building • Dealing with parents • Opportunistic screening question
GP & practice team education: The patient’s experience. Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
GP & practice team education-HEAR DVD Confidentiality Dealing with parents Real cases – GP role models Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
GP & practice team education: Mental Health summary, diagnosis, risk Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org Life Situation Altered thinking (ICE) Altered physical Altered emotional symptoms feelings Case:OC/PMT Altered behaviour
GP & practice team education: Clinical diagnostic & severity tool Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
GP & practice team education: Primary & community check list Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
Patient feedback on check list options http://www.youthhealthtalk.org/Young_people_depression_and_low_mood/Topic/3672 Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org http://www.youthhealthtalk.org/Young_people_depression_and_low_mood/Topic/3672
Resources: Web based self care: www.studentdepression.org Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
Web based self care:www.youngminds.org.uk Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
GP & practice team educationResource book- CWMT GP toolkit Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org The theory Case studies Self study activities with rationale for each GP & team consultation tools Reading material expanding on workshop sessions
Practical help- what’s around Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org • CWMT supported GP training • Train the trainers sessions ( PMHW) • Training to GP’s on the teenage mental health consultation
v Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
In summary Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org GP’s cant be forgotten if we want to help young people with mental health problems Young people voluntarily see their GP & can do “cradle to grave” GP’s have critical role in early detection, prevention & functional family approach
The last word – Jack Http://www.youthhealthtalk.org/Young_people_depression_and_low_mood/Topic/3673 Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Over to you Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org • Any unanswered questions? • What next?