England saw record 4.3 million referrals to mental health services in 2021
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o672 (Published 15 March 2022) Cite this as: BMJ 2022;376:o672Linked Opinion
Why has mental health been forgotten in the government’s recovery plans?
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Dear Editor
Various thoughts come to mind.
1. At what number of mental health referrals do we start having to redefine the accepted definition of the human condition and experience?
2. At what number of mental health referrals is the problem no longer in the health care in box and is clearly in the radical politics box? If our societal system and model can no longer deliver some elements of purpose and contentment for a huge proportion of the population then the system needs changed.
3. It’s become accepted and expected at some point in the last 10 years or so that a GP cannot deal with many mental health issues without referral.
4. Many mental health referrals just result in a restatement of the problem and letter back to the GP.
5. The content of many mental health care processes is just the same as the way a GP would have previously done it: a good history, a listening ear, a follow up, some simple medication and a safety net. Except that having referred, the GP steps back and does much less. Meanwhile the patient waits interminably.
6. The GP can provide multiple short consultations and support in a way that mental health services can’t. So we can end up referring to a service that provides less than us.
7. The self diagnosis of more significant mental health conditions and the seeking of validation of these diagnoses; adult autism, adult ADHD, bipolar, are driving some of this referral mania. People may be seeking a label for their human experience which of course already has a label: it’s called the human experience. The fact that their experience needs a label relates to points 1 and 2.
1 and 2 and 7 are above our pay grade for solutions. We could refer much less if it became accepted that the GP is enough. Beyond a certain wait time the referral becomes pointless. The GP has likely already stepped back in and done what was required anyway. Mental health is acute distress, apart from some personality issues. If “acute distress” has to wait months for relief the patient will no longer expect anything from the reliever: like a neglected Romanian orphan who switches off. It is the act of response to a distressed human being which achieves most in mental health issues. All you need is love. However no-one would ever actively create a waiting list for love.
Competing interests: No competing interests
Dear Editor
Dr. James is right that since 2020, professional advice on the mental health sequelae of Covid for the UK population has been ignored. A long term plan for the workforce required is certainly needed.[1] Sadly, past workforce "planning" failed to address either the scale of population needs, nor was it related to any consensus on the patient outcomes the "work" should achieve.[2] 2022 sees our mental health workforce depleted and exhausted. We need fresh ideas for a fresh start - and about 4.3 million people deserve that !
[1] Iacobucci G. England saw record 4.3 million referrals to mental health services in 2021. BMJ 2022;376:o672
[2] Caan W. Joined-up planning across the whole system is essential to improve mental health. BMJ 2017;358:j4199
Competing interests: No competing interests
Re: England saw record 4.3 million referrals to mental health services in 2021
Dear Editor
Graeme Mackenzie's response makes some really important points especially his points 6 and 7.
It is really hard to understand when unhappiness and melancholy transform into a mental health problem, and then when the expectations of society driven by social media that there is a 'cure' if you are referred to the correct source. We have seen massive prescriptions of SSRIs to young people where the evidence is that of a placebo (no harm if drugs safe). The tragedies of suicide get headlines that some part of the system has failed but evidence for suicide prevention from treatment is not exactly abundant (I am happy to be corrected).
The wishes for diagnostic labelling now reaches back to preschool and forward to adult lives; a genuine question is what are the benefits of such labels and what are the harms? The BJGP recently published that the term borderline personality disorder may lead people into a therapeutic vacuum with its causes linked to poverty and adverse childhood experiences, many of those linked to poverty.
In the distant past of GP training and Balint support groups, the phrase of 'prescribe yourself' and a listening ear with personal follow up were normal practice; now every consultation leads to referral -- this will then I assume be done by e triage and the family doctor will disappear.
Competing interests: No competing interests