Post on 14-Dec-2015
Teenagers consulting with
their GP & practice nurses
Dr Maryanne Freer07960718764
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:
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
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
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Quick quiz
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?
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Quick quiz
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?
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
The job of the “favoured” family doctor & practice team
The confidanteContinuityCradle to graveThrough physical health
managementFamily practiceMum/DadSiblings
Early detection & recognition
Urgents/crisis/ out of hours Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
Young people see GP’s voluntarily & through their own necessity.
E.g contraception needs
GP take a pragmatic, functional approach
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Further information:
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.
Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
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?Monday morning surgery Psychological or physical?
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Tom, 16 – Tom, 16 – acneacne ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Philippa, 36 – Philippa, 36 – crying – mum died suddenly 3 weeks agocrying – mum died suddenly 3 weeks ago ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Harold, 57 – Harold, 57 – indigestion and lack of energyindigestion and lack of energy ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Mary, 84 – Mary, 84 – cannot swallow and losing weightcannot swallow and losing weight ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Rob, 27 – Rob, 27 – recently diagnosed with schizophrenia – recently diagnosed with schizophrenia – drooling asking if this is a drooling asking if this is a side-effect of new medsside-effect of new meds ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Helen, 14 – Helen, 14 – tired all the time, irritable and sleeplesstired all the time, irritable and sleepless ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Roger, 20 – Roger, 20 – diabetic 4 years – poor diabetic controldiabetic 4 years – poor diabetic control ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Donald, 29 – Donald, 29 – sick note + pain-killers for back pain after RTAsick note + pain-killers for back pain after RTA ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Parva, 4 – Parva, 4 – regularly attends: yet another cough and coldregularly attends: yet another cough and cold ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Freda, 77 – Freda, 77 – depressed, early morning waking, no motivationdepressed, early morning waking, no motivation
What GP’s have to know- the “generalist”
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…
Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
GP’s main concerns - teenage mental health consultation
•“ 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
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
The GP * practice nurse consultation
Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
Zoe
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
Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
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
Confidentiality
Rapport building
Dealing with parents
Opportunistic screening question
Second consultation
Mental Health Summary Diagnosis Risk
Self help - problem Solving
MH Promotion check list
Consultation issues •Primary care probabilities
•Watchful waiting
•Clinical un certainity
•Management of physical co-morbidity
•Safety netting
•Use of continuity & follow up
•ConcordanceDr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org
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?
Resources
Consultation approaches
Education
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
GP * practice team education
Initial consultation
Confidentiality
Rapport building
Dealing with parents
Opportunistic screening question
Second consultation
Mental Health Summary Diagnosis Risk
Self help - problem Solving
MH Promotion check list
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
Life Situation
Altered thinking (ICE)
Altered physical Altered emotional
symptoms feelings
Case:OC/PMT Altered behaviour
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
GP & practice team education: Mental Health summary, diagnosis, risk
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
http://www.youthhealthtalk.org/Young_people_depression_and_low_mood/Topic/3672
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
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
The theory
Case studies
Self study activities with rationale for each
GP & team consultation tools
Reading material expanding on workshop sessions
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Practical help- what’s around
CWMT supported GP trainingTrain the trainers
sessions ( PMHW) Training to GP’s on the
teenage mental health consultation
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
v
In summaryGP’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
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org
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
•Any unanswered questions?
•What next?
Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org