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:
Sir Mark and Lady Rachel Waller- CWMT.
Dr Dick Churchill - RCGP Adolescent Task
Group
Dr David Shiers-GP& NIMHE
Professor John Spencer & MiC GP tutorsNewcastle 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
v
Dr Maryanne Freer www.cwmt.org 07960718764
maryanne.freer@pcpartners.org
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 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
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?
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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 –
side-effect of new meds
drooling asking if this is a
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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”
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?”
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
Second consultation
 Mental Health
 Confidentiality
 Summary
 Diagnosis
 Rapport building
 Risk
 Dealing with parents  Self help - problem
Solving
 Opportunistic
screening question
 MH Promotion check
list
Consultation issues
•Primary care probabilities
•Watchful waiting
•Clinical un certainity
•Management of physical comorbidity
•Safety netting
•Use of continuity & follow up
•Concordance
Dr 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
Second consultation
 Mental Health
 Confidentiality
 Summary
 Diagnosis
 Rapport building
 Risk
 Dealing with parents  Self help - problem
Solving
 Opportunistic
screening question
 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
GP & practice team education:
Mental Health summary, diagnosis, risk
Life Situation
Altered thinking (ICE)
Altered physical
Altered emotional
symptoms
Case:OC/PMT
Dr Maryanne Freer www.cwmt.org 07960718764
maryanne.freer@pcpartners.org
feelings
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
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 education
Resource 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
training
 Train 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
v
Dr Maryanne Freer www.cwmt.org 07960718764
maryanne.freer@pcpartners.org
In summary
 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
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/T
opic/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