Mental health clinics in GP practices is a great step – but we could go further

An article in Nursing Times recently reported that having a mental health clinic co-located within a GP surgery reduces referrals to secondary care.

A clinic such as this would operate to support patients who were visiting their GP with stress, depression, anxiety and mood disorders, among other issues. However, it is useful to go further still and look at the causes, as well as the effects and management, of these illnesses.

A 2016 study by the Mental Health Foundation discussed the links between poverty and mental health, which is just one social factor that we know can be a cause or a consequence of mental illness. Others factors include isolation, domestic violence, anti-social behaviour and unsuitable housing.

There are so many factors that influence our health and wellbeing that it is often nigh on impossible for somebody who is unwell and vulnerable to unravel these factors

In fact, in her one year review of the NHS Five Year Forward View, national mental health director Claire Murdoch praised the ‘visionaries’ from housing, education, prisons and voluntary groups for recognising the key role that they can play in addressing societal mental health challenges. There are so many factors that influence our health and wellbeing that it is often nigh on impossible for somebody who is unwell and vulnerable to unravel these factors and navigate the available services and associated administration on their own.

We find that people who struggle with these issues present at their GP practice with mental health symptoms as the core complaint. The GP is able to address a patient’s health needs and make appropriate referrals to dedicated mental health services, hence having the mental health clinic co-located can only be a big benefit.

But what about the root causes? What if spiralling debt is fuelling the illness? What if loneliness is restricting recovery?

The answer might be moving to a new community, but where do you start? How do you apply for new accommodation? How do you know if you are eligible? And what if you don’t even realise that the accommodation you are living in or a neighbour’s anti-social behaviour is the major driving force behind your mental health symptoms?

Significant impact

A GP may discover these issues during their 10 minute consultation, but they are unlikely to have the time and resource to guide the patient through all of their options.

This is where housing can step up and support GPs.

At Home Group, we have a number of services co-located within GP practices that have had a significant impact on patients living with mental illness.

Ann, for example, was suffering with depression, anxiety and epilepsy, and was struggling to look after herself in her former home. The stairs posed a health and safety risk due to her seizures but she struggled to obtain help from her private landlord. Ann felt that the only person she could turn to was her GP, who identified her housing and social needs and referred her to Home Group’s floating support service based within the practice as part of a CCG pilot scheme.

The service supported Ann in the application of a new council property, where she was swiftly placed on the high priority band and successfully secured a suitable new home within a matter of weeks.

We need to address an individual’s needs holistically to achieve the best outcomes

As Ann’s confidence was low, her support worker also encouraged her to take part in social activities and she was referred into one of our volunteers, peers and mentors teams. She now takes part in several new activities and has made new friends.

Consequently, the frequency of visits to her GP has decreased.

In line with the current talk of integration around health and social care, it seems ever more apparent that housing should also become part of this mix. We need to address an individual’s needs holistically to achieve the best outcomes.

Co-location within GP practices is taking us in the right direction. But we could push it even further and turn the idea on its head by incorporating clinical services within the home environment.

Home Group recently recruited a head of clinical practice, Dr Nichola Stefanou, who is looking at how we can make this a reality. We already have some services that benefit from visiting clinical partners, but by more fully integrating health and wellbeing into the day-to-day home environment we can deliver a more preventative approach.

So why not take health opportunities directly to the people who need them the most – those in supported accommodation. Be it healthy eating advice, smoking cessation classes or peer support groups, all of these initiatives help people to take more control of their self-care and have a more rounded approach to wellbeing. It makes healthcare accessible and encourages patient engagement. I for one am happy to have that first conversation.

Rachael Byrne is executive director, New Models of Care, Home Group. Rachael Byrne and Claire Murdoch will be delivering a free webinar with the King’s Fund on Monday, 19 June. To book your place on ‘The role of housing in accelerating discharge from mental health care services’, click here.  @byrnerae @homegroup