General practitioners (GPs) provided information, referrals, medical care and advice to carers providing support for a person with severe mental health problems. This Talking Point is about carers’ views of the role of GPs in supporting the person being cared for, and the relationship between the GP, the person being cared for and their carer.
Most carers we interviewed said they appreciated GPs who developed a good understanding of the history of the person being cared for. Many carers believed this led to better mental and physical health outcomes for the person cared for. It also meant neither carers nor the person being cared for had to, in Sue’s words, ‘go over’ the same information repeatedly.
GPs were often the ‘first port of call’, as Bronwyn put it, when the person cared for first started to experience mental health problems. Consequently, many carers felt GPs were in the best position – when the person cared for first became ‘unwell’ – to provide information and support to the person cared for and his or her carer. Many carers felt GPs needed to be better equipped to refer people to the full range of services they would need to build what Bronwyn described as ‘a support system’, and to do so in a coordinated way. Some carers specified that such referrals needed to include ‘non-medical’ support organisations, such as support groups, respite care and home care. A few carers wanted to see more case managers who could provide this coordination, and felt that the GP would be the best professional to explain to the person cared for and carers what a case manager did, and to refer them for case management (see also Advice for other carers).
Quick Links
Prescribing and monitoring medication
Carers and person being cared for’s relationship with General Practitioners
Bev would have liked it if her and her son’s General Practitioner had been able ‘from day one’ to refer them to ‘one particular spot’, which linked everything carers needed to know to better support the person being cared for towards recovery.
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Well, to start off with, I feel if someone presents themselves at their local GP, I would like to think that the GPs were able to direct you to one particular spot. All right, present with mental illness, [and the] GP was able to say, “”This is where you go and this is where you will start your journey with what treatment, what medications, what doctors you need to see””, and the rest of it.
When my son was diagnosed, we [were] just here, there and everywhere. Because I didn’t know anything about mental illness, that’s why I trusted the professionals. So I think we need to have a base, just one base. There’s too many organisations out there. There’s a lot of things we don’t know about. There’s a lot of things that aren’t advertised. They’re not known. You have to hunt them out for yourselves.
Even now the people I’m involved [with], in the groups, it’s just amazing what people don’t know that’s out there that they’re not advised of, and that’s what we need. We need to know what’s available to us, what help’s there, from day one.
Some carers commented that there were times when the person being cared for’s GP had not referred them to effective information or support. A few carers found that services they were referred to by GPs did not provide what they needed. This meant they had needed to approach a number of services before they found what they were looking for. It was also important to some carers that, as part of the ‘package’, as Bronwyn put it, of care their loved ones received, constructive communication existed between GPs and the mental health practitioners to whom GPs referred people. Many carers said they would also like to be referred by GPs to support services for carers because, as Julie put it, ‘[carers are] going to need help’.
Julie described how it was not a General Practitioner or a mental health practitioner but a ‘counsellor’ at a carer support organisation who gave her advice about alternative avenues she could pursue at a time when she had doubts about the ‘psychiatric care’ her daughter was receiving.
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But I guess the psychiatrist, I think he must have known. He knew we were, you know, not happy with what was happening. And we had a separate session with the psychiatrist. He didn’t at any point say, “”Oh well you could try somebody else””. He didn’t say that. And I guess the GP – there was no follow up from the GP to say, “”Oh come back in a few months’ time and tell me how it’s going””. There wasn’t any of that sort of thing.
So that’s where you certainly didn’t feel supported in that way. It was only in speaking to a counsellor at [non-governmental carer support organisation] who said, “”Well, you could try someone else. You should try cognitive behaviour therapy, you could try a psychologist””. That was helpful to go, “Oh, okay, so we shouldn’t – We’ve got other options”. But the medical profession wasn’t giving us other options.
Prescribing and monitoring medication
Many carers said GPs played a crucial role in prescribing the person being cared for’s medication, and observing its effects. GPs initiated new medication and provided ongoing prescriptions for some medication initiated by specialist mental health practitioners. A few carers would have liked GPs to pay more attention – beyond just prescribing medication – to their loved ones’ general wellbeing such as their emotional health and lifestyle concerns. One carer, Christene, felt that GPs held increasing responsibility for people diagnosed with ‘mental illness’ that was once the remit of mental health practitioners.
Jeannie felt that her son’s General Practitioner focussed predominantly on prescribing him medication.
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The next issue then is that GPs are the frontline. People go to them initially with anxiety, depression, whatever other symptoms of mental illness they’re dealing with and initial treatment is often at the discretion of the GP. Now most of them are pretty happy to prescribe antidepressants. However, these are not prescribed with a view of keeping tabs on the person, on monitoring their progress, dealing with possible side effects – just generally monitoring how these people are going.
Christene, a regional carer, felt that ‘more and more’ responsibility – including responsibility for prescribing medication – was being ‘put back onto’ General Practitioners.
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You know, you go to a GP. They’re a general practitioner. You don’t expect them to have the knowledge of the mind. But that’s what’s happening. Everything is getting put back onto your GP. This form, to be filled in by a psychiatrist, I was told, “Take it to the GP”. I’ve since fought the argument and the psychiatrist did sign it. But that took two weeks to win that argument.
But it’s coming back more and more [on] the GP [who] is the one that’s prescribing antidepressants, and they don’t have the training or the knowledge of some of these antidepressants. They don’t have the training and the knowledge of a psychologist or a psychiatrist. Yet this is what our psychiatric hospitals, our psychiatrists, are doing.
Carers and person being cared for’s relationship with General Practitioners
Many carers commented that GPs were unique among the medical professionals with whom the person cared for had contact, specifically with respect to providing continuity of care. Some families had stayed with the same GP for many years, which carers said allowed for relationships to develop that they felt were beneficial for both carers and the person being cared for. Bev described how she felt ‘very, very fortunate’ that her son had been seeing the same GP for the past 30 years since he first became ‘unwell’: ‘So, we have a very good relationship with him. [Son’s] GP understands the family dynamics and I can’t say how lucky we are to have that same GP. We don’t have to go over the same story all the time’.
Some carers were able to attend GP appointments with the person being cared for, and they said they appreciated the willingness of the person being cared for and his or her GP to include them in appointments. Several carers said attending the person cared for’s GP consultations was useful because it gave carers a chance – with the person cared for’s consent – to take notes, receive advice and discuss their observations with the GP.
Bev appreciated that her son allowed her to attend his appointments with his General Practitioner.
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My son has always wanted me to go with him to all his appointments. Yeah, I’m very lucky in that way that I’ve been able to sit in on all his appointments and listen to what’s being said. He agrees to that. I know there is some – rules is not the right word but he could say to me, “”I don’t want you to come to this appointment””, and he’s – by right, that’s the way it goes. So I’m very, very lucky that I’ve been able to sit there, listen to what’s – the interaction.
I try not to take over from what my son wants to say. I want him to say it as he sees it without me going over the top of him. So that’s why if it’s really important I try to let the professionals know. It doesn’t happen all the time. I can talk to them in front of my son and I might say, “Is there something else you would like to tell your doctor today, how you’ve been feeling the last week”. Or, you know, I’ll try to lead him into that path or the doctor will pick up because we have that long-term relationship. He will pick up that I’m trying to convey, ‘Yes, there’s something else happening’.
And that sounds to me really [to be] coming out of a concern of your own that his voice should be heard. Do you say that that’s part of [supporting] his independence or even autonomy in a way?
For sure. Yes, you know, I really feel that the doctors, professionals should listen to the person with the illness and listen to what they have to say and how they see their illness, their perspective of their illness. And if they can acknowledge that they do have an illness because even after a long, long time my son would not acknowledge that he had a mental illness. Yes, so I think the person should be heard and that’s why I try not to take over in an appointment but be subtle about it.
A few carers commented, however, that in their experience, when the person being cared for had found a GP with whom he or she had established a good rapport, it was not always possible to have the same GP as the person cared for’s regular doctor. In some instances, this was due to a GP relocating his or her practice or not always being available because he or she worked part-time.
Bronwyn believed that lack of continuing care by the General Practitioner who first diagnosed her son with mental health problems led to a lack of communication between the practitioners treating her son. She said this created the necessity for carers to be an ‘advocate’ for the person being cared for.
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She’s not available, she only works one a day a week so we’ve had to go with somebody else, at the same clinic though. So there’s no ongoing reporting back to the GP. There’s no communication between the specialist and GP. So the other thing is that my son’s not really aware of what he needs. I know it’s a bit of a male thing so I’ve got to take that into consideration too.
But then he might think of one thing he needs to go to the doctor for but I can see that this needs to be discussed and the doctor needs to know this and we need to set up that. And so really a mentally ill patient needs to have an advocate all the time just to make sure the medical people know what’s going on and to make sure they get the best possible care to go forward.
A few carers commented that GPs – particularly GPs who regularly cared for both the carer and the person being cared for – had been instrumental in encouraging carers to take time out to look after themselves (see also Carers’ experiences of caring for themselves).
Rowan’s stress levels peaked when he no longer had an income or savings which, as his GP alerted him to, put him in danger of having ‘a coronary’.
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Yep and while I was taking off unpaid sick leave, if you take off any length of time, and the doctor put me off for three months, a three month stint, because he said, “You’re not only burning the candle at both ends you’re burning it in the middle as well at the moment. You really need to look after your health”. My blood pressure had skyrocketed, my weight had gone up, my ‘I don’t care’ attitude was starting to really affect me a little wee bit and so much with – you let the bills, ‘Oh, I’ll worry about that later’.
Your sense of responsibility for other things that you would normally be very responsible for start taking the backburner, until all of a sudden they go from being something that could have been easily dealt with to suddenly like it’s like a, “Oh no, what am I going to do now, how am I going to deal with this?” That sense of responsibility, because you’re focussing too much on the person you’re caring for and trying to get over – especially if it was an acute admission – and trying to look after your own health.
But it wasn’t until I was at rock, rock bottom, that I was able to do anything about it and of course that had added to my stress level something shocking, and it was unnecessary because I could have actually done something sooner about it. And when I rang Centrelink – and this was a real bug bear – I rang Centrelink because I had to take, or the doctor said, “I need you to take time off work for yourself, because this is too much and you’re going to end up [either giving] yourself a coronary or something’s going to go wrong. You need to take three months off”. And I said, “I haven’t got sick leave. He said, “Well, you know, one way or another it’s either take it off for depression or take it off for a coronary”. And he was just showing that it could get a lot worse if we don’t do something about it now.
So I took the time off work, and of course – [had] no sick leave – so there was no income.
