Lack of GP training risks leaving people in the dark about side effects of psychiatric medication

Wednesday, 02 October 2019 Mind

People prescribed medication for their mental health aren’t being given enough information about side effects by their GP, with one in three people saying they would have liked side effects explained.

Mind’s annual Big Mental Health survey [i], asks people with mental health problems about their experiences of primary care and voluntary services.

The 2018 survey results of more than 12,000 respondents found that, when prescribed new medication for their mental health:

• Only one in five people (21 per cent) said they were definitely given an explanation about the side effects that the medication might have.

• One in two people (50 per cent) didn’t receive enough information about the purpose of their new medication.

GPs receive no mandatory practise-based training in mental health, despite more than 40 per cent of all appointments involving mental health and that demand is rising[ii]. Of all GPs who finished their training in 2017, less than half (46 per cent) completed an optional psychiatry placement[iii].

Mind is calling for a wider range of training in mental health settings to be available for GPs so they can feel equipped and confident to provide quality support for anyone struggling with their mental health, supporting them to make informed decisions about their treatment.

Medication works for millions of people in the UK, but some people report experiencing adverse side effects that are more severe than the symptoms of the mental health problem they are looking to treat. There are a number of types of medication prescribed for mental health problems, depending on your symptoms. For example, you may be prescribed antidepressants, antipsychotics or mood stabilisers. Possible side effects of antidepressants, including common brands like Prozac include decreased alertness, sexual problems, and mania.

Anyone thinking of starting or stopping medication needs to talk to their GP so it can be taken or stopped safely and gradually, with the help from a GP. Find out about psychiatric medication, on Mind's website - including possible side effects and tips for starting or coming off medication. 

Michelle Lloyd, 34, from London says:

“I first started experiencing mental health problems while at university and became very down, shutting myself away from people. My GP prescribed me an antidepressant called fluoxetine, but my symptoms worsened and I started self-harming, something I had never done before.

“The antidepressants were prescribed quickly with very little extra information about side effects. It was a horrible time; I also felt very nauseous with headaches and completely lost my appetite. I didn't expect the medication to make me feel so bad, I became really anxious about the effects the tablets would have on me in the long-term.

“The biggest side effect was the feeling of numbness - quite quickly I went from being someone who was over-spilling with emotions to not feeling very much, and that's quite scary. It’s not something I had been warned about.

“To this day I still haven't ever had someone explain properly how and why they work. I've had to do my own research to understand what was going on and what I was putting into my body, which is something I definitely feel can be improved upon. I feel all GPs and anyone working in primary care should have proper mental health training so they can help us when we finally visit them rather than disregard how we are feeling or do not give us the information we need.”

Mind’s Director of External Relations, Sophie Corlett, says:

“Our research revealed that a worrying number of us are receiving life changing treatment without fully understanding what it involves. This has got to change.

“GPs do an extremely difficult job often under inadequate time restraints. But, with GPs often the first port of call for mental health support, it’s crucial they have the opportunity to get the training they need to support patients to have the information to make decisions about their treatment.

“We know prescriptions of certain psychiatric medication are on the rise, for example, 6 per cent more prescriptions for antidepressants were given out in 2016/17 than the year before. Medication can be effective in managing symptoms of mental health problems, but not for everyone. It is critical people are told about potential adverse side effects, such as suicidal thoughts and self-harm, so they can make informed choices.

“People should be offered a range of treatments. But we know at a time of rising demand, mental health services are stretched, leaving GPs often feeling they have few referral options available. The NHS Long Term Plan comes with funding to improve mental health services and should result in GPs being better able to refer patients to a wider variety of treatments beyond medication, whether that’s talking therapies or social prescribing – signposting to alternative treatments such as arts therapy or exercise.”

Dr Seb Pillon, from Bolton, 35 says:

“Having the time to explain how side effects work is really tough in primary care - especially when the bulk of the consultation has probably already been used in establishing a diagnosis.

“I tend to prescribe medicines by comparing them to a crutch for someone who has broken their leg. For most people, the medication is a tool to help them either make the necessary changes in their lives, or to help them get through a difficult time. Likewise, some people need to keep using the crutch, and some don't.

"As there's more acceptance and understanding about mental health, GPs are going to see more and more patients with these kind of issues. I think additional training would help make sure all newly qualified GPs are confident in supporting people with problems like depression and anxiety, as well as related problems like alcohol and substance misuse, and chronic conditions like diabetes and lung disease, which often go hand-in-hand with poor mental health.

“It’s tough to provide a balance of facts to patient who is anxious without scaring them off something which may help. I'd like to spend more time with people. Sometimes I will end a consultation by directing the patient to resources (such as Mind - especially the YouTube channel) to research medications, and then discuss at a later date.”

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, responded to Mind's research and says: 

"GPs are specialist prescribers and will only recommend medications based on the individual circumstances of a patient, taking into account physical, psychological and social factors, and after a full and frank discussion around treatment options.

"This will always aim to include any common or potentially serious side effects, and an expectation of how long medication may take to work. We also ask patients, wherever possible, to familiarise themselves with the comprehensive information leaflets that should come included with every pack of their medication.

"Patients who have been prescribed medication for mental health conditions will be invited to have regular medicine reviews with their GP, and pharmacists will also be able to help with any queries or concerns.

"However, general practice is under extreme pressures and the standard 10-minute GP consultation is simply inadequate to properly deliver care to patients with complex health needs – which mental health conditions invariably are. We need greater investment in general practice so that we can spend more time with our patients.

"The College is also calling for longer GP training, based in appropriate community settings so that our future doctors are as prepared as they possibly can be to deal with the complexities of modern-day general practice."

The 2018/19 Big Mental Health Survey is open until 02 November. If you are over the age of 16 with personal experience of mental health problems, and have accessed or tried to access primary (GP or practise nurse) or voluntary mental health services in the last 12 months, such as support groups, counselling or similar psychological services) tell us about your experiences at the bigmentalhealthsurvey.com Your answers will help us to understand what currently works and how we can improve mental health services.

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