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Improving Mental Health Outcomes in Nottingham: Practical Strategies for GPs

This update discusses practical steps for non-specialist GPs to address drug and alcohol issues, including harm reduction strategies and spotting key clinical indicators. It emphasizes referral options and guidelines for managing mental health in patients with substance use disorders.

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Improving Mental Health Outcomes in Nottingham: Practical Strategies for GPs

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  1. Drug and Alcohol update PLT Nov/ Dec 2015 Improving Mental Health Outcomes in Nottingham Dr Stephen Willott

  2. What can non specialist GP’s do?1. talk more • Assess whether binge use or dependent • psychological vs physical dependence? • alcohol – use AUDIT & common sense • If dependent, refer to spa (RIN for drugs; Last Orders for Alcohol – include medical history, meds & any risk issues) • self referral ok for each • If not try brief advice & harm reduction

  3. 2.Harm Reduction • Thiamine for dependent drinkers at least 100mg daily (SIGN guidelines advise indefinitely) • Naloxone for those who misuse opioids (Prenoxad) • Beware of other prescribing • Beware giving long backdated sicknotes for those who are likely to misuse a cash windfall • BUT do use sick notes as an opportunity to encourage patients to get help

  4. 3. Alcohol issues not to miss • Raised BP

  5. Increased risks of ill health to harmful drinkers Source: Anderson P.(2007) The Scale of Alcohol-related Harm. [Unpublished] Department of Health

  6. 3. Alcohol issues not to miss • Raised BP • Depression

  7. Depression • Avoid antidepressants in dependent drinkers • Those who stop or cut down get >60% benefit in their mood / anxiety • So only prescribe if symptoms persist over 6 weeks after reduction • Can still refer to IAPT if F<35u / M<50u per week

  8. 3. Alcohol issues not to miss • Raised BP • Depression • Confusion • Sexual Health • Alcohol misuse guidelines on APC website • Shared prescribing allows for zero waiting list for specialist service

  9. 4.Medicine misuse • Awareness “Hooked on painkillers” BBC Panorama 11 Nov “RCGP factsheets” • Make sure familiar with the non cancer pain guidelines (APC website, max 60mg bd zomorph) • It is possible to say no

  10. 5. Hep C • Feb 2016 max 12w course • No side fx • >95% cure rate • But…£35k a pop • All the more reason to diagnose /refer

  11. Alcohol: www.last-orders.org The Health Centre,79a Upper Parliament Street,NottinghamNG1 3QN 0115 9709590 alcohollearningcentre.org.uk Drugs: RIN: www.recoveryinnottingham.co.uk 12 BROAD ST, HOCKLEY NG1 3AL 0300 300 2200 www.talktofrank.com Resources

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