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Teenagers consulting with their GP & practice nurses

Teenagers consulting with their GP & practice nurses. Dr Maryanne Freer 07960718764 Maryanne.freer@pcpartners.org. A problem shared is a problem halved. Introductions- myself. Thanks to:. Sir Mark and Lady Rachel Waller- CWMT. Dr Dick Churchill - RCGP Adolescent Task Group

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Teenagers consulting with their GP & practice nurses

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  1. 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

  2. A problem shared is a problem halved Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org

  3. Introductions- myself Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org

  4. Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org

  5. Thanks to: Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org 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

  6. v Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org

  7. Quick quiz Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org 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?

  8. Quick quiz Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org 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?

  9. The job of the “favoured” family doctor & practice team Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org • The confidante • Continuity • Cradle to grave • Through physical health management • Family practice • Mum/Dad • Siblings • Early detection & recognition • Urgents/crisis/ out of hours

  10. Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org • Young people see GP’s voluntarily & through their own necessity. E.g contraception needs • GP take a pragmatic, functional approach

  11. Further information: Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org 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.

  12. Why 10 minutes? Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org

  13. No mean feat……. Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org

  14. Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org

  15. 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 – drooling asking if this is a side-effect of new meds  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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

  16. What GP’s have to know- the “generalist” Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org 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…

  17. GP’s main concerns - teenage mental health consultation Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org • “ 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

  18. The GP * practice nurse consultation Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org

  19. Zoe Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org 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

  20. What tasks do you see the GP perform? Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org

  21. Tasks within the GP& practice nurse consultation Initial consultation Second consultation Mental Health Summary Diagnosis Risk Self help - problem Solving MH Promotion check list • Confidentiality • Rapport building • Dealing with parents • Opportunistic screening question

  22. Consultation issues Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org • Primary care probabilities • Watchful waiting • Clinical un certainity • Management of physical co-morbidity • Safety netting • Use of continuity & follow up • Concordance

  23. 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

  24. Do you know your GP’s? Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org Resources Consultation approaches Education

  25. GP * practice team education Initial consultation Second consultation Mental Health Summary Diagnosis Risk Self help - problem Solving MH Promotion check list • Confidentiality • Rapport building • Dealing with parents • Opportunistic screening question

  26. GP & practice team education: The patient’s experience. Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org

  27. 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

  28. GP & practice team education: Mental Health summary, diagnosis, risk 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

  29. GP & practice team education: Clinical diagnostic & severity tool Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org

  30. GP & practice team education: Primary & community check list Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org

  31. Patient feedback on check list options http://www.youthhealthtalk.org/Young_people_depression_and_low_mood/Topic/3672 Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org http://www.youthhealthtalk.org/Young_people_depression_and_low_mood/Topic/3672

  32. Resources: Web based self care: www.studentdepression.org Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org

  33. Web based self care:www.youngminds.org.uk Dr Maryanne Freer www.cwmt.org maryanne.freer@pcpartners.org

  34. GP & practice team educationResource book- CWMT GP toolkit Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org The theory Case studies Self study activities with rationale for each GP & team consultation tools Reading material expanding on workshop sessions

  35. Practical help- what’s around Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org • CWMT supported GP training • Train the trainers sessions ( PMHW) • Training to GP’s on the teenage mental health consultation

  36. v Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org

  37. In summary Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org 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

  38. 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

  39. Over to you Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org • Any unanswered questions? • What next?

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