Mental health remains the poor relation

GPs are having to deal with the rise in mental illness, and a more integrated approach to physical and mental health is vital, say Martin Lindsay and Marc Lester
GPs' surgeries see patients with mental health problems on a daily basis
GPs' surgeries see patients with mental health problems on a daily basis. Photograph: Frank Baron for the Guardian

The gulf between physical and mental health is huge, with just £11bn of the National Health Service's annual budget spent on the latter.

It's the classic iceberg syndrome, and what is starting to emerge from beneath the waterline of public awareness is just how many people are affected by mental illness at some time in their lives.

The rise in mental illness and its impact on society has long been predicted by bodies as diverse as the World Bank, British Medical Journal and Royal College of Psychiatrists. One in four of us will be affected by mental illness during our lives. Dementia will beset more than one million people in the UK by 2015, and many GPs see as many patients for depression as high blood pressure, which is the commonest physical ailment.

This increase is evident in the number of patients showing up at surgeries across north London with mental health problems.

This is reported to be as many as 50% of consultations in some surgeries, with common conditions including depression and anxiety.

It is a major concern within our profession, because GPs are often isolated and at the coalface of the problem. We see the impact of poor mental health on a daily basis and wrestle with the dilemma of what can be done within the confines of a 10-minute appointment slot.

It may be that the newly emerging clinical consortia boards provide an opportunity to redress the balance if given adequate financial resources.

One solution would be for primary and mental health trusts to pay greater attention to what GPs have to say. This would improve efficiencies without necessarily increasing costs.

A positive experience of this is our work with Barnet, Enfield and Haringey mental health NHS trust, which asked GPs what sort of additional training and support they needed.

This is, of course, limited by financial austerity, but includes the recent launch of a "one-stop" mental health referral service offering a faster, more responsive service that triages, screens and signposts patients to the appropriate service within 24 hours. This co-operative and practical approach to problem-solving is the way forward.

The trust is increasingly shaping services in alignment with primary care physicians and their day-to-day needs. This includes a primary care academy, which will provide GPs with training days, workshops and interactive multimedia events where they can learn more about various areas of mental health and share experience and best practice.

There are many reasons for the rise in incidence of mental illness, but two of the biggest contributing factors we see are the stress caused by increasing the age of retirement and the dynamics of the modern family.

Our society's fixation on material wealth and status is exacting its price as we work longer and harder, to the detriment of our own wellbeing. The global recession, and some employers' unspoken expectation that we work longer and harder, are contributing to the problem.

In our increasingly busy lives, it is worth stepping back and realising that our most valuable possession is our health. It may be a cliche, but the majority of us really don't understand that until something goes wrong.

We often give our house or car more attention than our bodies, and we see all around us the devastating impact of that behaviour reflected in the steady rise of heart disease, obesity, diabetes and a host of other largely preventable conditions.

People need to really understand that physical and mental health are interwoven. If your body is run-down and unhealthy it will affect your mental wellbeing, and vice versa.

It's about greater self-education and awareness, but it's also about ensuring that health services work more closely in partnership with one another and reflect the synergy of our own bodies and minds.

• Martin Lindsay is GP lead for mental health in Haringey, north London, and Dr Marc Lester is clinical director of Barnet, Enfield and Haringey mental health NHS trust

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