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Mental Health - Knives and forks, belly breathing and pupating caterpillars

Dr Rob Walker - 18 Jun, 2020

Thank you all for logging on and giving up your Tuesday evening last week to tune into our live Mental Health Webinar - it was a fascinating evening and one which was really made by all the interesting insights, stories and feedback on mental health resources that you sent through to us during the evening. Many of you asked for a compilation of the resources mentioned which we attach as a separate document for you to download and share with your colleagues and patients (I’ve deliberately done it on 2 pages so you can print/download page 1 for your patients and keep page 2 separate for you and your colleagues). Thank you to you all (including my GP colleagues, especially our ace Mental Health lead at CGH!) for sharing these excellent ideas and resources, and I would like to reiterate our thanks to Dr Catherine Sykes (Clinical psychologist) and Rosie Weatherley (from the fantastic mental health charity MIND) for giving up their time for free for the evening and for their resources and ideas.

Thank you all too for your honest assessments and stories from front line primary care during this most difficult of times. Many themes came out of the evening, most notably the confirmation from you all that the data Simon presented at the beginning was indeed a true reflection of our surgeries currently - we are seeing a LOT of people with mental health difficulties, in many many guises, with a concern that this is only the tip of the iceberg; many of you are clearly frustrated by the lack of access to mental health services in your areas and are concerned about how to cope with the increased demand we are seeing, with limited service provision. Many of you were also reflecting on how the stressors in peoples lives are changing now - initially much of it was related to fear of the virus itself and how to manage in isolation. Now lockdown is being eased, people are increasingly worried about the risks of opening up society, what are the risks when our children go back to school, and the longer-term finical impact COVID will have on them. However, it is important to put in context that many people have had some improvements in their wellbeing during the pandemic - a more simple life, less travelling and more time with immediate family have been really beneficial for many people; it’s important sometimes to try to look for the positives, even in such challenging times….

Isolation is inevitably a concern and impacts on everyone, but it was interesting that the data actually suggests younger people are more likely to have had their mental health affected during the COVID-19 pandemic than older people, with many of you rightly pointing out we need to be particularly aware of new mums who may be struggling with post-natal mental health issues, as many of the usual social interactions for new parents are unavailable. Previous pandemics have suggested we may see a significant increase in PTSD presentations and many were asking how we can help deal with this in primary care. Locally to me, a free 35-minute webinar has just been produced, specifically to help primary care with PTSD presentations - see the resources document for this.

How do we safely assess people with mental health illness remotely? A common question asked during the webinar, and one I’m sure we all have thought about. We are all feeling our way through this as there just isn’t the data/evidence to suggest how best to do this. Personally, I’ve found remotely assessing people with mental health difficulties not as hard as I thought, but it does have its challenges - we just don’t get that direct real-time visual feedback that we are so used to. Video consultations can help provide some of this and some people have found screening questionnaires (e.g. GAD-7 and PHQ-9) useful adjuncts. However, for a person we are really worried about, especially if they are vulnerable or have difficulty with communication, we do need to be thinking about how we can safely bring them down to our surgeries for face-to-face consultations.

So what have I learnt from this webinar, and from you? We should not 'under-estimate the power of our own clinical interaction’ as one of our colleagues rightly said - active listening, using empathy, and using ‘listening as a therapeutic tool’ can be incredibly powerful ‘treatments’. On the theme of treatments, one colleague gave a lovely ‘fork and knife’ analogy to help discuss with patients the psychological vs medications options - you can eat with just a fork (psychological therapies) but if things are tough you may need a knife (meds), however, it is best not to only eat with a knife, and a knife and fork together may give the best options!

Dr Catherine Sykes quite rightly discussed the importance of not being judgemental during such uncertain times - as the recent mental health awareness week has highlighted we need to be kind to ourselves and others and accept everyone is feeling their way through these difficult times, often with no right or wrong answers. The importance of relaxation exercises - Catherine talked about ‘breathing with your belly’ (see further information in the resources document). Many of you rightly pointed out the importance of exercise and activity to help wellbeing - whether it’s running (?couch to 5K?, going for a walk, Pilates, Zumba or Yoga (free sessions can be accessed through the NHS website - see link in resources document), or even digging out your old skipping rope (one thing I’ve done!). Many of you also pointed out the importance of enjoying nature in various ways - in our house, we have had caterpillars delivered via post (!) and they are currently pupating in their tub ready to transform into butterflies ( - no DOI needed! And one colleague directed us to Let’s share our nature ( where people can help share pictures for those not able to access nature directly.

And finally, we must not forget US. We need to look after ourselves to look after our patients. In the attached resources document I’ve pulled together some of the resources I/you have come across to help support us and our colleagues. ‘White space’ was an idea suggested by a colleague - 1-2 hours/week for staff to have some ‘me time’ either alone (meditation, reading etc) or together with other staff (e.g. socially distanced walk), but principally to get away from the computer. And don’t forget the importance of humour - whatever tickles your fancy, having a good laugh can often be ‘the best form of medicine’!

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