The #123GP Campaign has worked tirelessly in recent years calling for an increase in the provision of counselling in GP practices. They have my full support.
Like many people here I have been through the experience of going to my GP to ask for help with mental ill-health. I have been the person sitting in the waiting room running over and over what I will say to my doctor, how I will put into words the chaos in my head. Feeling the tension between my feet wanting to carry me out the door but knowing I was too exhausted to cope with this alone any longer. Having my name called and barely making it inside the consulting room before bursting into tears.
After I did my best to explain the huge thoughts and feelings that had brought me to that point my GP did not even mention counselling or other talking therapies as an option. She suggested only one thing – medication – something which I gladly accepted at the time as I was in desperate need of anything that might help. As it turned out, a painful few months later, I realised that this medication was not right for me and I had to find a new reservoir of strength to go back to my GP and make a specific request for a counselling referral. Even at this appointment, I was recommended a different drug and sent away with leaflets about it ‘just in case you change your mind’. However, my referral to the local talking therapy hub was in motion and after a bit of a wait I was able to access counselling that was very effective in helping me recover.
As essential as the practice nurse, the health visitor, the community midwife, the occupational therapist or the physio; bringing expertise around mental health that will enrich every aspect of the care people receive.
While I know that everyone’s experience is different and that medication is very effective for some, I was left with real concerns about the journey I had to make to get access to counselling. I don’t think that GPs prioritise medication over counselling because they don’t believe in the effectiveness of talking therapy. I suspect that the system is the main barrier, making it a less attractive option to present to their patients due to waiting times and lack of availability. When faced with vulnerable people in distress and possibly at risk, it must weigh heavily on doctors to send them away without something immediate to relieve their pain. By failing to commit to resourcing counselling services and ensuring genuine accountability around access times, the HSCB and the Health Department are putting front-line healthcare workers in an impossible situation.
I also suspect that the lack of priority placed on counselling by some GPs could be changed by further embedding counselling services as an essential part of the primary care available in GP practices. As essential as the practice nurse, the health visitor, the community midwife, the occupational therapist or the physio; bringing expertise around mental health that will enrich every aspect of the care people receive.
Placing counselling services at the heart of every GP practice could help build a consistent culture of respect and understanding when it comes to mental health.
I have conducted focus groups with other women who have asked for help with perinatal mental health issues on behalf of the Mas Project (Maternal Advocacy and Support). The findings demonstrate that many women do not feel confident in the skills and knowledge of GPs in dealing with perinatal mental health concerns. Some reported stigmatising language, downplaying their feelings or gatekeeping the care pathway by sending them away without onward referrals. Placing counselling services at the heart of every GP practice could help build a consistent culture of respect and understanding when it comes to mental health.
My experience is far from unique, in fact the evidence points clearly towards counselling being crucial to achieving good outcomes for patients and preventing more acute conditions. I can’t see any reasonable excuse for this crucial service being left out of the 10 year mental health strategy and hope that this will be rectified so people like me don’t have to fight for a service when we’re at our lowest point.
Kellie is a feminist activist working on campaigns with Belfast Feminist Network, Alliance for Choice and Reclaim the Agenda. She worked as the women's sector lobbyist with Women's Resource and Development Agency and is currently a PhD researcher at Ulster University. Kellie developed the perinatal mental health peer support network the Mas Project now coordinated by WRDA and delivered through women's centres with funding from the Lottery Community Fund.