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Psychiatry

This is what our GP trainees need to achieve during their time at your department. We've classified them under the six main compentency domains for general practice..

1. PRIMARY CARE MANAGEMENT

By the end of their GP Training Programme, the GP Registrar will:

• be able to provide treatment for people experiencing mental health problems, bearing in mind that several interventions may be effective for each mental health condition, including different forms of talking therapy, medication, and self help

• know specific interventions and guidelines for individual conditions, using where appropriate best practice as described in the SIGN or NICE guidelines

• avoid the habit of checking extensively for physical illness while not checking for psychological illness
o this can be bad for the patient and the NHS.
o Ideas about physical, psychological and social should be integrated in both consultation AND investigation of illness

• be able to screen, and diagnose people experiencing mental health problems, using effective and reliable instruments where they are available.

• know how to access health and social care organisations, both voluntary and statutory, that are an essential component of managing people with mental health problems

• be able to refer to and collaborate with the specialist mental health services (see appendix 6)

• identify early indicators of difficulty in the psychological well-being of children and young people
o respond quickly to concerns raised by parents, early years workers, teachers and others who are in close contact with the child or young person
o understand their responsibilities for supporting children in difficulty and know how to access support and advice from specialist CAMHS and CAMH workers in Primary Care

The knowledge base

Symptoms
• Tired all the time, insomnia, anxiety, depression, multiple somatic complaints, dizziness, palpitations, paraesthesiae, abdominal pain (children), early signs of possible psychotic illness

Common and/or important conditions
• The most common primary care mental health problems are depression, eating disorders, and anxiety disorders. ADHD, post-traumatic stress disorder. Alcohol and drug misuse (For a fuller list see Appendix 3)
Investigation
• Use of depression rating scales, and other aids to evaluation of possible diagnosis and severity
Treatment
• Pharmacology, CBT and simple behavioural techniques, problem solving therapy and basis of systemic and strength focussed therapies, Self-administered therapy.

Emergency care
• Threatened or attempted suicide, Delirium. Psychosis, Panic, Aggressive or violent patients, Drug overdose and alcohol withdrawal

Resources
• The family of the patient,
• Members of the primary health care team, receptionist, counsellor, CAB worker
• Specialist mental health services and non-medical agencies (non professional, lay or voluntary resources)

Prevention
• Mental health promotion, especially children, families and adolescents
• Screening of all language-delayed children for autism
• Early intervention in psychosis

2. PERSON CENTRED CARE

By the end of their GP Training Programme, the GP Registrar will:

• be able to engage with people experiencing mental health problems, to be able to elicit a persons un-edited story

• be able to enable people experiencing mental; health problems to fully engage in delineating their difficulties and deciding on appropriate interventions
o be able to work with people experiencing mental health problems to arrive at shared understandings, labels or diagnoses.

• appreciate the special challenges of rapport building with patients with mental health problems
o have developed the necessary rapport building skills for challenging patients

• understand that the concept of concordance is particularly important in mental health care
o be able to present individuals with choices as to which intervention may work best for themselves
o understand that this ability to choose improves the effectiveness of the intervention

• understand the importance of continuity of care for people with mental health problems
o co-ordinate care management to enhance doctor-patient continuity

• be able to demonstrate gender-specific communication skills

3. PROBLEM SOLVING SKILLS

The knowledge base

Treatment
• Pharmacology, CBT and simple behavioural techniques, problem solving therapy and basis of systemic and strength focussed therapies, Self-administered therapy.
Emergency care
• Threatened or attempted suicide, Delirium. Psychosis, Panic, Aggressive or violent patients, Drug overdose and alcohol withdrawa

l
Resources
• The family of the patient,
• Members of the primary health care team, receptionist, counsellor, CAB worker
• Specialist mental health services and non-medical agencies (non professional, lay or voluntary resources)

Prevention
• Mental health promotion, especially children, families and adolescents
• Screening of all language-delayed children for autism
• Early intervention in psychosis

Specific problem-solving skills
By the end of their GP Training Programme, the GP Registrar will be able to:

• assess the prevalence of mental health problems and needs amongst the practice population
o This may include the use of valid instruments, and the use of practice registers for specific conditions in association with recording data as part of nGMS
• screen and diagnose people experiencing mental health problems, using effective and reliable instruments where they are available.
o having an awareness of people at risk for mental health problems (see appendix 7)
o be able to understand and appreciate the difference between depression and emotional distress
o be able to identify mental health problems which are covert or somatised
o be able to assess risk / suicidal ideation
o being aware of issues about the effectiveness of screening, early identification, watchful waiting and stepped models of intervention
• deal with uncertainty that certain patients produce
o frequent attenders, patients who demand drugs, chronic suicidicity in borderline personality disorder

Moved from Psychomotor skills
By the end of their GP Training Programme, the GP Registrar will be able to perform a:

• Mental state assessment
• Suicide risk assessment

4. COMPREHENSIVE APPROACH

By the end of their GP Training Programme, the GP Registrar will have:

• the ability to deal with the associated physical health problems of people with mental health problems
• the ability to screen and diagnose people with physical illness at risk of mental health problems
• an understanding of the principles of mental health promotion (see appendix 5)

5. COMMUNITY ORIENTATION

By the end of their GP Training Programme, the GP Registrar will:

• have an awareness of the extent and implications of stigma and social exclusion
• challenge inequality
• be able to work in partnership with other agencies to secure appropriate social interventions for individuals
• be able to work in partnership with other agencies to secure wider public health of the local population
• be able to contribute to the health improvement programme that reflects the perspective of the local population
• understand the importance of avoiding medicalising some mental distresses
• be able to debate the ethics the of use of psychotropic drugs to sedate people for social reasons and to practise ethically

6. HOLISTIC APPROACH

By the end of their GP Training Programme, the GP Registrar will:

• understand the impact that social circumstances can have on mental illness and that recovery is contingent on the effective management of those social circumstances
o an understanding of the concept of recovery and the principles of promoting recovery - (see appendix 8)
• understand that a model of mental illness that creates an artificial separation between mind and body is often unhelpful - particularly in understanding psychosomatic complaints, psychological consequences of physical illness and somatisation
• be aware that our understanding of mental illness is culturally determined and depends on assumptions that may not be universal
• demonstrate cultural sensitivity

All these 6 domains have a

7. Contextual Aspect

The GPR should
• have sufficient knowledge of the current Mental Health Act to undertake the responsibilities that this requires of general practitioners

8. Attitudinal Aspect

By the end of their GP Training Programme, the GP Registrar will:

• Understand that their own attitudes, and feelings are important determinants of how they practice,
o people who self harm
o people who misuse drugs or alcohol
o people who know more about their illnesses than their doctors do
o people who engender strong emotions in us for many reasons.
• Understand the importance of self-awareness issues for the doctor such as family of origin issues and personal prejudices.
• GPs should have personal management plans for how they manage their own mental health
• Understand the need for reflective practice

9. Scientific Aspect

By the end of their GP Training Programme, the GP Registrar will:

• Adopt a critical and research based approach to practice is particularly important in mental health, where evidence on effective treatment is often of poor quality.
• Understand the major part that drug companies play in promoting use of psychotropic drugs
• Recognise the use of value judgements in psychiatric diagnosis and understand the concept of a values-based approach to mental health.