How to make an appointment with a UK GP for mental health issue?
November 20, 2013 8:51 AM   Subscribe

OK, I know how to make an appointment with a GP, but I need a bit of advice with how to navigate the logistics of making the appointment and getting the best out of that appointment.

I am experiencing an extended period of anxiety that has resulted in panic attacks and depression. It is affecting my work and is getting worse. I'd like to make an appointment to see a GP, but have hit many snags...

-- Firstly, I had to change GPs because I moved out of the catchment area of my old GP. Filling out forms was an absolute pain because I couldn't find my NHS number and couldn't remember a lot of details about my history and my previous GPs. I finally found a local place and submitted an online registration form, but I need to go to sign forms and have a general registration check-up. I know a few things that will result from this check up (I'll need to have an asthma clinic check, I need a smear test, I need a flu vaccine) and considering that these will all take time and it's a short check up, should I bring up my mental health problems or make a separate appointment?

-- Secondly, one of ways I behave when I'm anxious is to avoid making or answering phone calls. This makes it very hard to ring up the doctor and ask for their advice. So, while I know I could easily solve the issue of when to bring up a mental health issue by ringing up and asking, I just hate talking on the phone.

-- I was referred to a CBT counsellor on the NHS when I was 13 for bullying-related anxiety, and I found the experience to be profoundly unhelpful (to be fair, because I was using it as an excuse to cut school). Now I'm an adult and have never been diagnosed with a mental health problem, but I do remember that CBT involves a lot of tasks that felt like 'homework' that I then failed to do and made me feel even more useless.

-- More recently, I went to talk therapy at my uni's health centre (I'm a PhD student), and while I was more receptive to this therapy and felt temporary benefit, I have not seen any lasting changes to my work or mental health.

-- I know not to diagnose myself before seeing a doctor, but because I've had less-than-stellar results with therapy alone, a bit of me really wants to be diagnosed with SOMETHING so I can be medicated and just STOP feeling the way I do. There is also a family history of severe depression, learning difficulties and a couple of psychotic disorders. Right now, I'm so messed up that I'd almost feel relieved if I were diagnosed as ADD or bi-polar disorder, because there would then be treatment to 'make me better.' I know, rationally, that this is not true and offensive to sufferers of these chronic disorders, but the temptation remains to guide a diagnosis toward medication as well as therapy. How do I curb the temptation to manipulate any possible diagnosis?

I guess I just want advice about what I say to my new GP, and to be assertive without trying to tell them how to do their job. Is it appropriate to say that I want a psychiatric referral, or is that something I should leave to them to decide?
posted by anonymous to Health & Fitness (7 answers total) 5 users marked this as a favorite
 
should I bring up my mental health problems or make a separate appointment?

It's pretty common for the general registration check-up to be done by a nurse rather than one of the GPs, so yes, I'd suggest making a separate appointment. Plus, like you say, it's a short check-up; you can definitely bring up your mental health problems then as well as at a later appointment, but given how much of an issue they are for you right now it probably makes more sense to make an appointment with a GP just for dealing with that issue.

In my experience, these check-ups are really brief - urine test, blood pressure, fill in a form, height/weight sometimes, answer a couple of questions and you're done. They're not like a regular GP appointment.

I guess I just want advice about what I say to my new GP, and to be assertive without trying to tell them how to do their job. Is it appropriate to say that I want a psychiatric referral, or is that something I should leave to them to decide?

I would just go in there prepared to say what's happening with you at the moment, what's happened with you in the past (including your family history), and say you'd like a psychiatric referral. The GP will either say yes, or not just yet; either way, they should be trying to put something in place to help you in the meantime. Don't worry too much about manipulating the diagnosis, being just the right degree of assertive, etc. I do the same thing with doctors so I get why that's a concern for you, but really, it's over-thinking the situation and you can't predict how the particular GP you're speaking to will react anyway. Just tell them what you're dealing with and answer their questions honestly and directly. If you don't get on with the GP, or if the GP refuses to give you something you feel like you need (treatment or referral or whatever), you can always ask to see another GP at the practice.
posted by Catseye at 9:27 AM on November 20, 2013


I'm currently doing my psychiatry rotation in a UK medical school so hopefully I can clarify a few things:
- GPs are trained to treat mood and anxiety disorders which are mild-moderate. If you get some resistance if you ask to see a psychiatrist, that will be why.
- Medication does exist for depression and anxiety! Don't try to manipulate your diagnosis towards bipolar or ADHD. Even if you successfully conned the doctor into prescribing medication for one of those, they wouldn't help at all as they are completely different meds with completely different effects.
- When you see the doctor, mention that you've had CBT and talk therapy in the past and found them unhelpful. You may find that trying CBT again as an adult is different, and I do want to emphasize that CBT is effective for a lot of people with depression/anxiety. If you decide against it, you could probably still be prescribed medication!
- Finally, depression and anxiety are legitimate medical diagnoses. They are no less legitimate than bipolar disorder and ADHD. There are treatments available. You can and will feel better one day!
posted by snoogles at 10:01 AM on November 20, 2013


I did a 6 week CBT course for anxiety through the NHS and although it does involve some homework, it is not an insurmountable amount, and would have definitely felt more like homework if you were already doing homework at school.

I found it fantastically helpful, alongside anti depressants that I was prescribed first, and it has left me with mental tools a year later to deal with current anxiety.

I totally get your avoidance of phone calls, make a little script with what you want to say beforehand. You can ask them if the check up will be with a nurse or a doctor; if it is with a nurse, ask to book a doctors appointment immediately afterwards. If it is with a doctor, ask for a double appointment.

Best of luck, I know how scary this can feel.
posted by ellieBOA at 10:11 AM on November 20, 2013


Good advice above, just coming in to reinforce that just because CBT was unhelpful before, it doesn't make it not worth trying again.

Citation: I saw several therapists of different kinds, including CBT, before I met one who really, really helped. He was a CBT practitioner as well, but his methods were different to all the previous people I'd seen.

I really do think therapists are like dentists. Especially on the NHS. If it hurts too much, or the pain doesn't go away after, get a new one.
posted by greenish at 10:11 AM on November 20, 2013


I'm sorry you're suffering.

You say you don't like talking on the phone - does that also extend to speaking face-to-face? If not, why not pop in and have a quiet word with the receptionist - you don't have to go into details (or could ask to speak privately to them) but you can legitimately ask whether it would be best to book two separate appointments. Don't forget, you can sometimes get a double appointment as well, which should give you and the GP time to go over both sets of issues.

As far as depression goes, my GP said he saw it very much like a broken leg - it's an illness that you wouldn't leave to heal by itself. As said above, it is absolutely a valid standalone diagnosis that can be treated quickly and effectively.

Anxiety, too - I have had several extreme bouts of crippling anxiety and they were treated very successfully with anti-depressants, to the point where I am thinking and acting (and more importantly feeling) like myself again. Oddly, one resource I found that helped me was No More Panic, a website that provides a safe space for people with various forms of anxiety and related disorders to exchange experiences and help each other. For me, just reading about what others were going through and seeing that my anxieties were not uncommon really helped settle my mind.

As for CBT, the only therapy I've ever had was CBT and like you I found it less than helpful - but I also believe that it can help others, it would depend on the relationship between you and the therapist and I would consider it again if it became necessary.

Good luck.
posted by Martha My Dear Prudence at 11:10 AM on November 20, 2013 [1 favorite]


Seconding that GPs are often perfectly willing to prescribe meds for depression or anxiety, or refer for counselling, without (or before) refering to a psychiatrist. This could be on the strength of a short appointment where they ask some diagnostic questions about how you're coping, etc.

They may also want to know if you want a medical certificate to be signed off work, but as a PhD I would guess it's probably between you and your supervisor as to whether you require some time off, and if so whether the university needs some medical evidence.
posted by wilko at 1:01 PM on November 20, 2013


Ask for a double appointment. It'll give you a bit more time with the GP to be able to talk about how you're doing without so much pressure to get done as quickly as possible.

If you think there's a possibility that once you get into the appointment you might struggle to explain what is actually wrong, then write down all your symptoms, what you're worried about, and your history of previous therapy, and take the notes into your appointment with you. You can then either use them as prompt cards for yourself, or if that turns out to be too difficult, then just hand the notes over to the GP, and let them read it directly so they know what questions to ask you.

Also - some GP surgeries allow you to book appointments through a website, so you wouldn't need to talk to anyone over the phone. Try Patient Access to see if your GP surgery is participating.
posted by talitha_kumi at 9:24 AM on November 21, 2013


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