Developing the skills to deliver an integrated model for mental health in primary care

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INNOVATION IN MENTAL HEALTH EDUCATION IN THE UK FOR GPS.

Introduction

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Developing the skills to deliver an integrated model for mental health in primary care is an area lacking in investment within the UK.

Government policies fail to focus on local and individual GP requirements for the complexity of mental health work.

The following workshop offers an opportunity to

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Experience specifically designed primary care focused education

Gain an awareness of the emphasis on redesigning services to meet individual needs

Develop skills which can be used in a 10 minute consultation

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basrse

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basrse

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basrse

Master class anxiety and depression

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How to deliver mental health skills in a primary care setting requires practical techniques as well as knowledge. This training is unique in that it is designed to meet the development needs of General Practitioners and staff working within primary care settings.

It will be case study based and focus on the spectrum of depression and its links to anxiety, psychosis and suicide.

Right Brain Functions Left Brain Functions

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Non Verbal Visual Spatial Emotional expression Imagination Fantasy Inventiveness Dreams Artistic ability Musical ability Involuntary memory Humour

Verbal Speech Reading Writing Comprehension Logic Critical Ability Numeracy Intentional Memory Time

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Between logic and emotions, which will always win?•People who are high on emotion are not rational (eg road rage)•We need to calm our patient down before we can reason with them.•We do this by therapeutic rapport•Men tend to want to give advice on how to solve the problem, but for women empathy is more important.

Psychological and Physical health are l inked

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The only way to separate the mind from the body is with an axe.

Physical illness causes stress Stress may result in functional symptoms

and organic alterationThe mind and body are one “We knew all this but no-one had brought

it together before”

We like people who are like us

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Hence mirror and match body language

Keep your breathing slow so they match you

EXERCISE 1

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You are running lateYour least favourite patient has come in

AGAIN with his/her usual problem(s)Do your best to just get them out of the

room as fast as possible by not listening, interrupting and being a “bad” clinician

EXERCISE 2

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Now try again Give the patient the first couple of

minutes of the consultationSee how long your patient can talk

for with a receptive listener.

BATHE

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B: BACKGROUND What is going on in your life?The first two minutes belong to the patient.

A: AFFECT How do you feel about that?Summarise the feelings – the underlying message is “I have been listening/ I am here for you” It

helps the patient to hear their own feelings externalised reflected and summarised T: TROUBLE What troubles you most about that?What is the worst thing about this situation? = a focus Underlying messages 1.We can talk

about anything here 2. Our time is short so we must focus H: HANDLING How are you handling that?The important thing is to manage this situation and not get stuck in overwhelming feelings. The

underlying message is “You can handle this situation” E: EMPATHY That must be very difficult for youNormalise the situation for the patient - empathy means it sounds awful, and anyone would feel

like this in this situation.

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e n g a g i n g p e o p l e

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How to Ask About Suicidal Thoughts

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Possible questions to ask when inquiring about suicidal thoughts.After each question respond with appropriate empathy and then move on to the next step.

5. How do you feel in yourself?6. How does the future look to you?7. How do the next few days look?8. Have you reached rock bottom?9. Can you face tomorrow?10.Do you feel that there are only problems and no solutions?11.Have things got so bad that you feel you may harm yourself in some way?12.Have things got so bad that you have had thoughts of ending your life?13.Do you feel that you just can’t carry on ‘like this’ or do you actually want to die?14.How long have you had these thoughts?15.Are they changing / getting worse?16.How do you manage to resist these thoughts?

Refer for specialist opinion/start working on a crisis plan to resist the thoughts

Human needs

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Security-a safe territory-a space to growAttention (to give and receive)Having a sense of Autonomy and ControlEmotionally connected to others-intimacyBeing part of a wider communityThe need for privacy to reflect and consolidate experienceSelf esteem – via confidence and achievementThe need to be stretched which comes from a sense of meaning and purpose.