When a person is experiencing psychological or emotional difficulties (hereafter called "mental health problems"), they may well attend their GP. The GP will interview them and based on the nature and severity of the persons symptoms may either recommend treatment himself or refer the person on to a specialist. There can seem a bewildering array of such specialists, all with rather similar titles, and one can wonder as to why they've been referred to one specialist rather than another. In this article I give an outline of the qualifications, roles and typical working styles of these specialists. This may be of interest to anyone who is about to, or already seeing, these specialists.
Although not a mental health specialist, the GP is a common first contact for those with mental health problems. A GP is a doctor who possesses a medical degree (usually a five-year course) and has completed a one-year "pre-registration" period in a general hospital (six-months on a surgical ward and six-months on a medical ward as a "junior house officer"). Following this a GP has completed a number of six-month placements in various hospital-based specialities – typical choices include obstetrics and gynaecology, paediatrics, psychiatry and/or general medicine. Finally, a year is spent in general practice as a "GP registrar" under the supervision of a senior GP. During this period, most doctors will take examinations to obtain the professional qualification of the Royal College of General Practitioners ("Member of the Royal College of General Practitioners", or MRCGP). Others qualifications, such as diplomas in child health, may also be obtained.
The GP is thus a doctor with a wide range of skills and experience, able to recognise and treat a multitude of conditions. Of course the necessity of this wide range of experience places limits on the depth of knowledge and skills that they can acquire. Therefore, if a patient's condition is rare or, complicated, or particularly severe and requiring hospital-based treatment, then they will refer that patient on to a specialist.
Focusing on mental health problems it will be noted that whilst the majority of GP's have completed a six-month placement in psychiatry, such a placement is not compulsory for GP's. However, mental health problems are a common reason for attending the GP and, subsequently, GP's tend to acquire a lot of experience "on the job".
Most GP's feel able to diagnose and treat the common mental health problems such as depression and anxiety. The treatments will typically consist of prescribing medication (such as antidepressants or anxiolytics) in the first instance. If these are ineffective, alternative medication may be tried, or they may refer the patient to a specialist. GP's are more likely to refer a patient to a specialist immediately if their condition is severe, or they are suicidal, or they are experiencing "psychotic" symptoms such as hallucinations and delusions.
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