Talking mental health with Dr Liz Lee

/ 2 August 2017

The most common mental health conditions are anxiety and depression which can vary greatly in severity, causing anything from mild distress and unhappiness to suicide and disabling anxiety that prevents someone from leaving the house or engaging with work and social activities.

Although depression and anxiety are the most common, there are a huge range of mental health conditions from eating disorders, to addiction, to personality disorders. Some conditions, like schizophrenia and bi-polar disorder, can require a lifetime of medication and support from psychiatric services.

But how can you get help if you think you’ve got a mental health problem, what can GPs do to support you, and what is the secret to a healthy mind? We caught up with GP and mental health specialist from the show, Liz Lee, to ask some of our burning questions.

  • Why do you think mental health is sometimes taboo?

“For some people, especially among men and the elderly, it is still very difficult and takes some courage to come to the GP to discuss these sorts of problems. Some people no doubt see anxiety and depression as a sign of weakness and this hinders them from seeking help.

“I think that, certainly in some groups of the population, there as a slight lessening of this taboo though – the idea of putting your feelings into words is now recognised as being important.”

  • What’s the first thing you should do if you think there’s a problem with your mental health?

“If you have active suicidal feelings then you need to see a GP urgently and should tell reception that it’s potentially a life threatening emergency when booking your appointment, or ask for a same day telephone consultation with the GP and explain how you’re feeling. If you are unlucky and neither of these approaches work, the alternative is to go via A&E.

“If you aren’t feeling suicidal but think there’s a problem, talk to family and friends if you can to see if they are worried about you and have a look on the NHS website as there’s lots of sensible advice there. Ask yourself if it is a problem that is getting worse, does it come and go, and might it be normal to feel sad or anxious sometimes?

“If it doesn’t feel ‘normal’ to you and it’s not getting better over a period of two weeks, ring the surgery and book a routine appointment to see the GP.

“Schizophrenia and bi-polar are different to depression and anxiety in that those affected usually have no insight into what is happening and have to be brought in for help, sometimes even having to be forcibly treated under the Mental Health Act.”

  • Should you see a GP about your mental health?

“It depends on what works for the patient. GPs can make a diagnosis in most cases, following which a treatment plan can be developed, but some people prefer to see a private therapist or call a support line such as Samaritans or Cruse to talk about the problem.

“There is also a tendency for people to put aside feelings of depression and anxiety in the hope they will get better themselves – which they often do.”

  • What happens when you go to a GP with a mental health problem?

“The GP will talk about how you are feeling, paying particular attention to specific negative thoughts. If a major mental illness is suspected the GP will also be trying to illicit abnormal beliefs and thinking patterns. The GP and patient can then try to identify increasing stressors like alcohol and drug intake.

“Many patients are greatly helped just by starting this conversation, and most come back for further appointments to monitor the improvement or deterioration of the symptoms.”

  • What treatments can GPs offer?

“GPs can prescribe for both depression and anxiety (the amount of prescriptions has seen a huge increase lately) or refer patients to the IAPT service which is available nationwide and offers a number of talking therapies, mostly based on Cognitive Behaviour Therapy. Because CBT is an ‘educational program’ it means the patients learn how to self-manage some of their problematic negative thoughts and its positive effects have been shown to be well maintained in many people a year or two after treatment has finished. Both CBT and antidepressants are helpful in treating depression and anxiety.

“For major mental health disorders GPs refer patients to the psychiatric service. If it’s an emergency the Crisis Team will visit someone within four hours, but most are triaged and seen at a later date which can be up to three months later. Patients are mostly supported by the psychiatrists for long periods of time and eventually discharged back to GP care when they are less unwell.”

  • Is there a long waiting list for counsellors on the NHS?

“It varies for CBT but my patients get assessed within three weeks and treatment starts within 10 weeks. Some surgeries are piloting in-house mental health nurses who look after patients and offer counselling.”

  • What alternative ways can you receive mental health support if not via the normal NHS route?

“There are lots of charities in the field offering support and treatment as well as local support groups. There is also private therapy – you can get anything from full psychoanalysis for one hour three times a week (for years), to private CBT for just twelve one-hour sessions over 3 months.”

  • What are your tips for maintaining a healthy mind?

“Physical and mental health are intertwined so keeping fit and reducing addictive behaviours will surely help one as much as the other – yoga works on this principal.

“There’s also Mindfulness which, although it hasn’t been proven to prevent initial depression, has been shown to reduce relapse in patients with recurrent depressive disorders so it’s good for maintenance therapy.

“Generally, it’s important to find your own way. Talk to someone you trust about worries if they become oppressive. I personally walk and think, make sure I have some fun every week and keep an eye out for changes such as sleep disturbances, increasing tearfulness and loss of enjoyment of normal things.”


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