When I was involved in a study exploring access to primary care mental health care, our researchers were based in GP practices. One problem I remember clearly was that in a locality where there were many people who did not speak English, or who were illiterate in their own language, there seemed to be a difficulty in waiting rooms which relied solely on screens to tell people it was their turn, and where to go. It’s a simple thing, but it caused delays and frustration in reception. The aim of the training we did for practice staff was to try help them to put themselves in the shoes of people with mental health problems.
- How might you even be aware that you needed help for a mental health problem? There is still considerable stigma, especially in some ethnic minority communities – something I discovered when we talked to women from a South Asian background in the North West of England.
- How do you find out about mental health problems, and the services available in your area? What information is available? Who wrote it and is it freely available or do you need to be computer literate to obtain it?
- Where do you have to go to get help? Can you self-refer? What else is available in your community that might suit you better and do practice staff know about these organisations? Are they are still running? Have they visited them? We found that practice staff may never have made contact with the third sector organisations on the same street as their surgery.
- What is it like making an appointment, and visiting reception if you are very distressed and anxious? How are you received? Sometimes people don’t try until they are in crisis and then can get angry – which can be misinterpreted as aggression.
- What’s your experience of seeing a professional? How confident are you that they understand mental health care? Do you get all the information you need? How is interpretation carried out – if you need it? Do you feel that there is someone who you can turn to who understands the whole system? (when I worked in a primary care mental health service, I empathised with the GPs who told me that they could never be sure of the times when the crisis service was open and whether there were any limitations on who could contact them, for example were they only for people already known to services, could people be referred by GPs, or could people self refer? Service changes weren’t adequately publicised and it could be very frustrating indeed.
Then there is your experience of the referral process to specialist care ...
How do services contact you to let you know about when you will be seen? How can you contact them? Many people have told us about problems with leaving answerphone messages that are not responded to. Do they explain the process sufficiently? Some IAPT (improving Access to Psychological Therapy) services offer fast assessment but then there is a very long wait for treatment. What should you do if you feel worse in the meantime?
We found that attending appointments at health centres was difficult for women without childcare and older people with transport problems or who were afraid of or unable to travel – but home visits were often unavailable as were appointments at the GP surgery. Are there other options using technology that some people might prefer, such as email, text, telephone or online? Are they available, and if so, do you know how a person might access them?
NICE have provided guidance on improving access to mental health care, but to personalise the experience it’s an incredibly useful exercise to work with patients, service users and carers in your locality and ask them ‘What is it like for you here?’
This is the first in a blog series to coincide with the release of Relias' new mental health training courses for primary care. To discover how our online courses and learning management system can ensure your staff are delivering the highest quality care, request a conversation with a member of our team.
Next in our blog series, Linda Gask discusses the interface between primary and specialist mental health care. Subscribe above to ensure you don't miss future posts.