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Professor Helen Lesters presentation of the James Mackenzie Lecture

Publication date: 22 November 2012

Don’t just screen, intervene -  top GP calls for better care for mental health patients

People with schizophrenia, bipolar disorder and other serious mental illnesses are still getting an unfair deal from their healthcare - yet subtle changes in the attitudes and actions of health professionals could significantly improve the quality, and even the length, of their lives.

That was the key message from Professor Helen Lester in her prestigious James Mackenzie Lecture to the Royal College of General Practitioners’ Annual General Meeting.

Professor Lester called on GPs to make people with serious mental illness their “core business” and to adopt a new mantra to improve their care: don’t just screen, intervene - and from an early age.

She said that GP consultations were not always long enough to address the myriad of physical, mental and social issues, and that despite a greater susceptibility to cardiovascular disease, many people with serious mental illness were missing out on simple tests such as blood pressure checks because of the way in which GP surgeries are run and the stigmatising views some GPs hold about people with serious mental illness.

Professor Lester suggested that GPs and other health professionals could implement a series of simple measures to make their surgeries more welcoming and improve the experience of the consultation.

These could include:
- red flagging notes for receptionists enabling patients with serious mental illness to book appointments with a GP who already knows them and save them from having to repeat their medical history;
- having a designated waiting area outside the GP’s surgery, away from what can often be noisy waiting rooms;
- giving patients with psychosis longer appointments or the last appointment of the day;
- encouraging GPs to examine their own attitudes towards people with serious mental illness to ensure they always go that extra mile.

Whilst acknowledging that people with serious mental illness were more likely to die at a much earlier age than the general population (up to twenty years earlier for men (Wahlbeck 2011)).  Professor Lester challenged the commonly held view that patients with serious mental illness ‘never recover’, citing research to show that at least 15% of people make a full recovery and 50% overall having a good outcome.

She concluded: “The health and health care of people with serious mental illness is our business. People with schizophrenia and bipolar disorder need better care than they currently receive. I hope you see that there are many things that cost little, that are based on simple observations not rocket science, that we could introduce tomorrow into routine general practice.

“GPs need to remember that we can be the holders of hope. We need to say repeatedly at the start of the illness that 50% of people make a good recovery so that people don’t feel written off.”

ENDS

Wahlbeck K, Westman J, Nordentoft M, Gissler M, Munk Laursen T. Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry 2011; 199: 453–8.
The lecture can be viewed in full on Youtube http://www.youtube.com/watch?v=tqyACm5OQOM

Helen Lester MB BCH MD FRCGP
Professor Helen Lester is the Chair of CIRC. She is a GP and Professor of Primary Care at the University of Birmingham and is also chair of the Society for Academic Primary Care. Helen has published over 100 research papers as well as books and book chapters in the fields of primary care mental health, early intervention and quality improvement. She is the RCGP mental health commissioning lead and co-chairs the national cross College Joint Commissioning Panel for Mental Health. Professor Lester also gave evidence to the recent Schizophrenia Commission report ‘The Abandoned Illness’ http://www.schizophreniacommission.org.uk/the-report/

The James Mackenzie Lecture is delivered at RCGP’s Annual General Meeting. Nominations for the lecturer are submitted to the Awards Committee of the College. The topic of the lecture usually relates to an aspect of clinical medicine; it is normally published in the British Journal of General Practice.

Further Information

RCGP Press office - 020 3188 7574/7575/7576
Out of hours: 0203 188 7659
press@rcgp.org.uk

Notes to editor

The Royal College of General Practitioners is a network of more than 46,000 family doctors working to improve care for patients. We work to encourage and maintain the highest standards of general medical practice and act as the voice of GPs on education, training, research and clinical standards.