Mental Health Toolkit

The following tools may be used for recognising, diagnosing and helping patients with a mental illness.

Care pathways and clinical guidance

The following resources aim to improve identification and provide advice on the assessment of mental health conditions, and advice on treatment pathways

• Depression and anxiety spectrum disorders general care pathway
• Global Mental Health Assessment Tool (GMHAT) guidance note for GPs
• NICE’s identification of common mental health disorders and pathways to care 
• Diagnosing anxiety: the generalised anxiety disorder assessment 
• Diagnosing depression: the patient health questionnaire (PHQ-9)
• Comparison chart for medications used for mental health conditions [PDF]
• Carers and confidentiality in mental health

Information factsheets for clinical guidance

The following factsheets offer guidance for approaching a range of common situations which may cause mental health problems for patients. 

• Debt and mental health website and factsheet 
• Early detection of emerging psychosis 
• Medically unexplained symptoms guidance and RCGP Ten Top Tips for addressing Medically Unexplained Symptoms 
• Monitoring of patients prescribed lithium
• Top tips for GPs on Eating Disorders

Perinatal mental health

The following resources specifically focus on perinatal mental health, and provide best practice and treatment pathways, as well as national guidelines.

• RCGP's Perinatal Mental Health toolkit A collection of resources launched in July 2016 to assist both GPs and patients to identify and treat perinatal mental health issues.
• Ten top tips to consider regarding perinatal mental health 
• Perinatal mental health best practice and pathways 
• NICE guidelines for antenatal and postnatal mental health 

Mental health in partnership with physical health

• The NICE approved Lester cardiometabolic intervention framework for patients on antipsychotic medication
• Improving the mental health of people with physical health problems
• Early intervention in psychosis - keeping the body in mind
• Healthy Active Lives (HeAL) consensus statement: Keeping the body in mind in youths with psychosis
• Treating depression in people with coronary heart disease 
• The management of patients with physical and psychological problems in primary care
• Improving the physical health of people with serious mental illness - a practical toolkit
• Living Better patient information leaflets offering advice for patients with long-term conditions on coping with low mood, depression and anxiety.
• Treating Depression in People with Coronary Heart Disease [PDF]
• Improving the physical health of adults with severe mental illness: essential actions a report by the Academy of Medical Royal Colleges.
• WONCA Severe Mental Illness Resources
• Ten top tips to protect the physical health of patients experiencing psychosis

Mental health and smoking

People with mental health problems die on average 10 to 20 years earlier than would otherwise be expected, and a large proportion of this difference is due to tobacco use.

• The Stolen Years - the Mental Health and Smoking Action Report 2016
• Primary Care Guidance on Smoking and Mental Disorders and Pharmacy Guidance on Smoking and Mental Disorders
• Smoking cessation and mental health: A briefing for front-line staff [PDF]
• Helping smokers quit
• Mental Health and Smoking Partnership: Statement on Electronic Cigarettes

Dementia

• RCGP clinical dementia resources
• Alzheimer’s Society resources for GPs
• GMC guidance and training references
• Post diagnosis support and QOF dementia review: best practice
• Dementia Roadmap - resources for local areas for primary care to support people with dementia
• Patient information leaflet about health and social care resources available after diagnosis
• Dementia core skills education and training framework
• Social care institute for excellence dementia resources

Mental Capacity

• Mental Capacity Act 2005 at a glance
• BMA Mental Capacity Act toolkit and Daisy Bogg Consultancy Mental Capacity Act toolkit

Quality Improvement

To access shared learning networks to assist you in applying practical QI methodologies to better treat this clinical area, join our QI Ready platform.

The following factsheets offer guidance for approaching a range of common situations which may cause mental health problems for patients. 

• Top Tips for addressing Medically Unexplained Symptoms 
• Top Tips for GPs on Eating Disorders
• Top Tips to consider regarding perinatal mental health
• Top Tips to protect the physical health of patients experiencing psychosis

• Suicide Prevention Top Ten Tips factsheet

• Ten top tips for managing self harm in children and young people

• Bullying in Young People: Tips for GPs

• Suicide in children and young people: Tips for GPs

• Psychodermatology: Tips for GPs 

Crisis care

The mental health crisis care concordat is a national agreement between services and agencies involved in the care and support of people in crisis. It sets out how organisations will work together better to make sure that people get the help they need when they are having a mental health crisis. The resources below can be useful within mental health crisis care:

• Mental Capacity Act (2005) decision making pathway 
• Options for getting help in a crisis - summary for GPs, patients and families 
• The Mental Health Act: sectioning explained
• Information sharing and suicide prevention - consensus statement on information sharing
• Clinical Guide: Assessment of suicide risk in people with depression Centre for Suicide Research at the University of Oxford

Suicide prevention and risk assessment

The following tools assist GPs in the recognition of suicide risk, and give clinical guidance for assisting those who may be at risk of taking their own life:  

• Staying safe website - Information about how to make a Safety Plan can be found on this website for anyone struggling with suicidal thoughts or supporting someone else. It’s designed  to offer hope, compassion and practical ideas on how to find your own way forward.
• RCGP Suicide Prevention Top Ten Tips factsheet
• Suicide mitigation in primary care a factsheet with resources and trigger questions for identifying suicide risk [PDF]
• Assessment of suicide risk in people with depression [PDF] 
• Centre for Mental Health and Safety 
• National Suicide Prevention Alliance an overview of all different organisations involved in preventing suicide
• Papyrus UK: prevention of young suicide
• Safer care for patients with personality disorder . Primary care lessons from this report: Psychotropic medication may be taken in fatal overdose, emphasising the importance of safe prescribing in mental health services and primary care. Risk in personality disorder is linked to co-existing drug and alcohol misuse, showing the need for substance misuse services to be available.    

• Learning for whole practice

• eLearning: suicide prevention

• Information sharing and suicide prevention: Consensus statement

Suicide bereavement resources

• Survivors of bereavement by suicide a web resource of local and national support groups
• Help is at hand a booklet produced for those who have lost someone close to suicide

One in ten young people aged 5 to 16 suffer from a mental health disorder. The following links offer toolkits and pathways you may find useful when helping a young person who is displaying signs which may be linked to mental health issues:

• Joint intercollegiate statement on children and young people's mental health
• RCGP resources for young people and their families 
• The mental health consultation (with a young person) a toolkit for GPs [PDF]
• Young Minds
• MindEd elearning resources to support young minds 
• Talking treatments for depression in young people 
• Anti-bullying Alliance 
• Student Minds 
• Child and adolescent mental health elearning module
• Stem4 - stemming teenage mental illness 
• Living with self harm Resources and films from healthtalk.org

Factsheets

• Early Detection of Emerging Psychosis [PDF]
• Early Intervention in Psychosis: Keeping the Body in Mind 2014 [PDF]
• Self-harm in young people Information for parents, carers and anyone who works with young people

Resources for children and adolescents

• Beat eating disorders
• Coping with self-harm: A guide for parents and carers by the Centre for Suicide Research at the University of Oxford
• Big White Wall a community of people who are anxious, down, or not coping
• Youth in mind For stressed children and teenager, and those who care for them
• Calm harm provides tasks that help the young person resist or manage the urge to self harm.  They can add their own tasks too and it’s completely private and password protected.
• No Harm Done Three short films, co-created with young people, parents and professionals, reflecting their real-life experiences of self-harm

Publications

• The mental health of young people: the view from primary care BJGP editorial, Oct 2016, Faraz Mughal, Elizabeth England
• Digital approaches to mental health for children and young people Clinical News, Feb 2016, Faraz Mughal, Elizabeth England

"Mental health services are failing older people" the latest research from Age UK highlighting current gaps in care for older people's mental health. 

Leaflets and factsheets

• Managing depression in older people

Improving mental health services for people with Parkinson’s who experience anxiety and depression

While the physical symptoms of Parkinson’s such as tremor, slowness of movement and rigidity are familiar, less attention has been paid to associated mental health and cognitive symptoms such as psychosis, impulsive and compulsive behaviours, hallucinations, mild cognitive impairment, dementia, anxiety and depression.

The All-Party Parliamentary Group (APPG) on Parkinson’s has chosen to focus this inquiry on access to psychological support for people with Parkinson’s who experience anxiety and depression, due to the commonality of the symptoms and the impact on quality of life.

Palliative care 

The large number of people with mental health problems living in the community makes research into the palliative care and last-stage oncology needs of this population especially relevant. The following reports provide information and guidance on this topic:

• Positive partnerships palliative care for adults with severe mental health problems, a report providing guidance for palliative care for people with severe mental health problems [PDF]
• Mental health and palliative care a review of literature exploring the extent and nature of palliative care for people with mental health problems.
• Psycho-oncology detecting, measuring and treating psychological distress in patients with cancer.

Dementia and vision – improving vision can improve quality of life

Correcting the vision of a person with dementia can improve their quality of life. If a patient is not having regular sight tests, suggesting that they visit an optometrist, or telling them about NHS funded domiciliary eye examinations if they cannot attend a practice unaccompanied, might make a big difference.

The College of Optometrists has undertaken NIHR funded research, the PrOVIDe study to explore the prevalence of a range of vision problems in people with dementia aged 60-89 years, and to explore to what extent are these conditions undetected or inappropriately managed.

Further information can be found here

The following resources can be passed to patients, and people close to them

Charities

The following charities may be used by patients to learn more about their mental health condition, and read case studies of others who have suffered and been treated for them. They also provide a handy contact resource for questions outside of GP surgery hours.

• Alzheimer’s Research UK
• Bipolar UK 
• Cruse Bereavement Care 
• Dementia UK 
• Depression Alliance 
• Depression UK 
• Mind
• National Service Users Network (NSUN) 
• Relate for relationship issues 
• Responsible Gambling Trust
• Rethink Mental Illness 
• Samaritans 
• Time to Change an anti-stigma campaign run by the leading mental health charities Mind and Rethink Mental Illness
• Tommy's for mental health issues surrounding pregnancy
• Sands stillbirth and neonatal death
• Sane resources to improve quality of life for anyone affected by mental illness
• Childline 
• Papyrus UK prevention of young suicide 
• Devolved Nations: SAMH (Scottish Association for Mental Health), NIAMH (Northern Ireland Association for Mental Health), AMH (Action Mental Health Northern Ireland)

Self help resources for patients

• Royal College of Psychiatrists patient information leaflets A-Z of up to date accessible information of all mental health conditions, and a series of online videos about leading mental health issues
• Patient.co.uk an online information and forum resource for all medical conditions
• Depression, anxiety and support amongst Muslim communities 
• Reading Well books on prescription 
• Information about psychiatric drugs an online resource designed to educate patients
• Understanding psychiatric diagnosis in adult mental health a leaflet by the BPS
• Time to Change
• Maryland Recovery - Anxiety Quiz learn if you struggle with anxiety and addiction
• MindEd for families - a free educational resource on children and young people's mental health for all adults

How to discuss mental health with your GP

• Find the words a short film and guide on how to make the most of your GP appointment
• How to talk to your GP about mental health A PDF booklet about speaking to your GP
• But... Sometimes - A challenge of anxiety a blog and five minute narrative short film exploring Anxiety and the difficulty in seeking help.

Speeding up return to work

• Fit for work - a free service for people who have been off work, or are at risk of being off work, for 4 weeks or more. People can self-refer, be referred by their employer or by their GP. It provides occupational health assessments and support aimed at enabling a safe and speedy return to work.

Cognitive Behavioural Therapy resources (all free but some require registration)

• Royal College of Psychiatrists information on cognitive behavioural therapy 
• MoodGYM an online training resource teaching cognitive behaviour therapy skills for preventing and coping with depression
• Living Life to the Full an online life skills course that aims to provide access to high quality, practical and user-friendly CBT training
• FearFighter and MoodJuice online resources for the treatment of panic and phobia.
• Beating the blues; Overcoming fears; Solving daily problems online advice for people with mild to moderate conditions

Resources for carers

• Carers, family and friends what you need to know
• Carers Trust and specifically for mental health carers
• Carers direct hotline 0300 123 1053
• Quarriers support for carers in Scotland
• NHS Choices information page for carers

The following resources may benefit a patient suffering from mental distress, who does not yet want or require treatment:

• Changing Minds relaxation tools and wellbeing resources in different languages which may be suggested to patients
• Mindfulness for GPs and primary care teams and Mindfulness for health and wellbeing meditative techniques to assist patients to recognise their own mental state and manage feelings
• Relaxation Exercises
• The Foundation for Positive Mental Health skills training for positive mental health, derived from Olympic sports 
• Reading Well Books on Prescription was launched in 2013 with a list for common mental health conditions including anxiety, depression, phobias and some eating disorders. The RCGP has worked with Reading Well Books on Prescription since it began and has been involved in reviewing book lists and books and providing advice.
• The Responsibility without Blame Project provides a free and accessible e-learning for anyone interested in thinking about our ideas of responsibility and blame, and finding ways to work and relate more effectively with people with personality disorder or complex needs.

Many doctors find it hard to acknowledge their own mental health issues and put off seeking help. The following resources are aimed towards supporting healthcare professionals cope with stress and other issues which may arise as a result of practising medicine.

• Overview of GP wellbeing resources
• NHS GP Health Service
• Help me, I'm a doctor helps distressed doctors and their dependents to identify charities and funds to support them when in  financial need. They include a range of people's situations. Individuals are then advised to make an application.
• The Doctors Support Network
• BMA resource of websites and support groups for doctors in difficulty
• BMA counselling and doctor adviser service a 24 hour hotline that offers support and problem solving advice (08459 200 169)
• The GP Lifestyle - Wellbeing in General Practice an online course offering advice on stress management, alcohol, nutrition, exercise and substance misuse
• The Foundation for Positive Mental Health offers free access to GPs seeking skills training in positive mental health for their own benefit. Use the code 'sthelaj' within the website or app.
• Find the words a video from Mind to encourage awareness among GPs and practice staff about healthcare professionals' mental health.
• DocHealth a confidential, not for profit, psychotherapeutic consultation service for all doctors.
• The Vital Signs: A guide for doctors seeking help and advice by Royal Medical Benevolent Fund

Trainees in difficulty can contact the Professional Support Unit in their respective deaneries for free support with ill health while training.

Current national and legal guidelines for healthcare professionals to follow regarding mental health issues:

English and Scottish guidelines

• NICE guidance on mental health and wellbeing
• Mental Capacity Act 2005 at a glance and the RCGP Mental Capacity Act toolkit for adults
• Mental Health Taskforce a mental health 5 year forward view for the NHS in England
• Scottish Intercollegiate Guidelines Network (SIGN) guidelines
• Improving the physical health of adults with severe mental illness: essential actions a report by the Academy of Medical Royal Colleges.

Mental Healthcare in other nations

• Primary Mental Health Care and Services Wales
• Welsh government mental health priorities
• WaMH in PC a list of useful websites for primary care mental health professionals and practitioners across Wales - including links to useful background information about the Mental Health (Wales) Measure
• NI Direct resources for people affected by mental health in Northern Ireland
• Well Scotland
• World Federation for Mental Health 
• Integrating mental health into primary care: A global perspective [PDF]

The RCGP training curriculum for mental health issues ensures GPs start with an understanding of the demands of working with people with mental health problems and the need to make sure they remain healthy. The following resources may be accessed for continuing and developing this purpose, and for providing evidence for Appraisal and Revalidation.

RCGP elearning modules

• Alcohol management in primary care
• Child and adolescent mental health
• Eating disorders
• Gender variance
• Improving access to psychological therapies
• Mental health in older people
• The GP lifestyle - wellbeing in general practice
• Suicide prevention

Other elearning

• RCGP elearning directory (select Mental Health Problems directory)
• NICE anxiety disorder recognition
• Mental Health First Aid England
• Connecting with People bite size training modules
• Alcohol misuse online training courses

Developed in partnership with the Clinical Innovation and Research Centre, the guidance and resources within the Mental Health toolkit reflect current guidelines. They provide a toolkit to which general practitioners may refer to recognise and diagnose mental health conditions, as well as suggesting the best management options for a particular patient.

Commissioning Information

• A commissioner’s guide to primary care mental health
• No health without mental health a guide for clinical commissioning groups.
• Joint commissioning panel for mental health a collection of guides regarding the commissioning of different mental health conditions
• NHS commissioning - mental health as a group C national programme of care
• Collaborative care planning - guidance for commissioners
• Standards for psychological support for adults living with HIV
• Tooling up and gearing up mental health in primary care: Transforming and strengthening the role of mental health in primary care A primary care workforce training and education framework, checklist, and summary of education and training provided in London 

• Mental Health Core Skills Education and Training Framework: This framework was commissioned and funded by the Department of Health and developed in collaboration by Skills for Health, Skills for Care and Health Education England.

• The Consensus Statement for People with Complex Mental Health Difficulties who are diagnosed with a Personality Disorder

Suicide bereavement resources

• Survivors of bereavement by suicide a web resource of local and national support groups
• Help is at hand a booklet produced for those who have lost someone close to suicide

Policies and Reports

• Falling through the gaps an executive summary of the report recommending changes in perinatal mental health care
• Preventing suicide in England: two years on a report on cross-government outcomes strategy
• Right here, right now CQC report into the role of GPs in crisis care
• Mental health promotion and prevention in general practice

• Psychological dimensions of dementia: Putting the person at the centre of care. A report by the British Psychological Society Dementia Advisory Group

• The British Psychological Society understanding the psychological dimensions of dementia to improve care