APPENDIX FIVE – GENERAL PRACTITIONERS VERBATUM RESPONSES
TO QUESTION 12.
“I would appreciate it if you could write a short note on what your views are in
relation to the role of counselling and/or psychotherapy in primary care.”
“Counselling and Psychotherapy have a huge role to play and access and affordability
are the two barriers to using a non pharmaceutical approach to difficult psychological
problems at GP level.”
“Difficult sometimes to know whose fully accredited and whose not. Question at the
dividing line between ‘Psychotherapist’ and ‘Counsellor’? Same or different?
Fantastic treatment option for mental health problems but difficulty with a) access and
b) knowledge of reliability.”
“Counselling & Psychotherapy are very important in primary care. Many problems
have psychological aetiology and most problems have psychological implications. GP
interactions with patients involves a lot of informal counselling. It is very important
that we have skilled counsellors and psychotherapists available for the more
intractable and difficult problems.”
“Not enough counsellors available.”
“Very useful ***** service. Essential to a multidisciplinary primary care service.”
“Important role in primary care for many mild/moderate symptoms of both anxiety
and depression, or where non-medication intervention is required.”
“Many mental problems need either no medication or medication in tandem with
counselling/psychotherapist/psychologist. GPs need to work in tandem with the “nondrug” services. GPs need to prescribe a lot less particularly for anxiety and also given
recent information on depression. Best treatment evidence based options should be
known to GPs (they are not). Counsellor/psychotherapist should be proposed enrolled
in a state approved service (= medical council). These services should be free to
medical card holders & subsidised for others.”
“I feel it is invaluable to help caring for people with mental distress.”
“Very important in primary care. Cost and accessibility is the biggest factor.”
“GMS Patient → Psychiatric Service → Psychology Service. These patients (GMS)
cannot be referred directly to a psychologist as they have to be reviewed by
psychiatric services initially which is totally a waste of services.”
“Lack of services. Poor access except if private. Patients complain of cost.”
“It would be wonderful to have counselling services available. Its very time
consuming part of GP work. We have excellent public mental health service readily
on referral to service patient is assessed and then is seen by either counsellor /
psychologist / social worker / psychiatrist. It is difficult to get counsellor readily when
mental health service not required.”
“1. Of Benefit to some patients. 2. Lack of feedback to Dr. therefore no follow up. 3.
Should be better communication/meetings between therapist and GP.
“Greatly needed as many problems can be solved this way and indeed help prevent
some into the future. However I feel some ‘counsellors’ are not good at encouraging.
people to leave the past and move on. I sometimes feel they may prolong a problem
by repetitive dwelling on same.
“Very necessary but will not share treatment concern and will not issue letters of
update of final conclusion.”
“ Very important role in management of ****** mental illness. Restricted by
availability on GMS. Many attend privately.”
“I have relationships with 3-4 Counsellors i.e. Psychotherapists. In general, I don’t
think Therapists need to be “in-house”. I do find it helpful to discuss patients so it is
useful if he/she is in-house. Experienced Psychotherapists seem to need less and less
liason.with GPs. I would love closer co-operation and HSE funded in practice
psychotherapists for GMS patients.”
“Supportive role in many non psychiatric mental disorders. V-helpful in many cases.
V-supportive in helping GP cope with large burdens of mental distress, and time not
available usually in 10 minute consultation to counsel (especially as other physical
matters also dealt with.”
“I would greatly value a state funded CBT service to refer to. Many chronic anxiety &
depressed patients, too great an emphasis on sedatives and poor understanding by
patients of their psychological problems. Used to work in inner city London where
there were good NHS services, practice had and attached clinical psychologist. Much
more hit and miss here.”
“Invaluable but not accessible enough. Supportive to patients in distress – my time
[is] limited. Potentially prevents reoccurrences. Helpful in conjunction with meds.
where appropriate.”
“Underutilised and under resourced. The lack of access to the psychological services
is appalling”
“Essential, not ******”
“Would be beneficial to have one overall referring body accrediting therapists. Lot of
population requiring acute services are financially compromised. Greater funding /
resourcing by state would be helpful. Ideal world, one tier health service for all
funded by ****** taxation!!”
“Important asset.”
“We do it ourselves every day!!”
“Both required but need to be state-sponsored and adequately remunerated for
counsellors/psychotherapist.”
“Very important role. Big part of our workload involves dealing with patients with
stress / anxiety disorders and depression. Need more counsellors & psychotherapists
for our patients unable to afford private fees. I am wary of therapists with antimedication approach.”
“I agree with current evidence that it has a lot to offer in the treatment of mental
health problems. It is very frustrating that the HSE does not offer this type of service.
In fact the whole of the mental health service leaves a lot to be desired and is over
reliant on in-patient treatment, which as a result is over burdened.”
“Every day in general practice – nowadays – many people present with problems
which G.P. is not trained to treat. The services of counsellors and or psychotherapists
are invaluable in their assessment and treatment. Only problem is they are thin on the
ground.”
“Very important. More needed.”
“Very necessary but often not immediately accessible.”
“Given the nature of things in the HSE at present the usual response will be ‘no
funding’. I feel that 2-3 core team need a dedicated psychology & psychotherapy
service linking directly with GP, psychotherapy service and community nurses.”
“I would very much like to see the provision of more services for patients.”
“Any person can counsel. Traditionally Parent Priest Doctor good friend. It is perhaps
an attempt to get the patient to see their problem in perspective and make decisions
accordingly. Psychotherapy can only be performed by people who have training in
psychology and attempts to explain in a deeper way peoples emotions and suggest
ways of manipulating those emotions.”
Note 1 (***** means the word could not be read)