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Teenagers consulting with their GP & practice nurses Dr Maryanne Freer 07960718764 Dr Maryanne Freer 07960718764.

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Presentation on theme: "Teenagers consulting with their GP & practice nurses Dr Maryanne Freer 07960718764 Dr Maryanne Freer 07960718764."— Presentation transcript:

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

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5 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

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7 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

8 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

9 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

10  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

11 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

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

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15 Monday morning surgery Psychological or physical? Monday morning surgery Psychological or physical? --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Tom, 16 – acne ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Philippa, 36 – crying – mum died suddenly 3 weeks ago Philippa, 36 – crying – mum died suddenly 3 weeks ago ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Harold, 57 – indigestion and lack of energy ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Mary, 84 – cannot swallow and losing weight 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 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 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” 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

17 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

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

19 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

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  Confidentiality  Rapport building  Dealing with parents  Opportunistic screening question Second consultation  Mental Health  Summary  Diagnosis  Risk  Self help - problem Solving  MH Promotion check list

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

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?  Resources  Consultation approaches  Education Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org

25 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

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 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

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  http://www.youthhealthtalk.org/ Young_people_depression_and _low_mood/Topic/3672 Dr Maryanne Freer www.cwmt.org 07960718764 maryanne.freer@pcpartners.org

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 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

35 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

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37 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

38 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

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


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