More GPs take on mental health cases

This story was first published in The Straits Times on April 5, 2013

MORE doctors in neighbourhood clinics are now managing patients with mental health conditions. And patients have welcomed the arrangement.

A partnership with the Institute of Mental Health (IMH) to have stabilised patients cared for in the community has seen the network of general practitioners (GPs) grow from 34 in 2009 to 53 today. And more than 1,300 patients have been referred to their care from IMH since the partnership was forged in 2005.

Programme director and IMH consultant psychiatrist Goh Yen Li said the initiative has been a success so far.

In a survey of 114 patients early last year, more than 90 per cent reported high levels of satisfaction, citing reasons such as "the GP spends time listening to me" and "the GP was patient".

Said Dr Goh: "GPs are often the first point of contact for patients with mental illnesses. This places them at the forefront in detecting, treating and referring a patient with mental illness."

Any GP can assess a person for mental illness and, if required, refer him to a specialist at a public hospital. But GPs under the partnership will manage stable patients after they have received specialist care.

To help these doctors along, training is provided by the IMH.

A one-year graduate diploma programme was started in 2010 to train GPs on how to recognise and manage mental disorders. IMH plans to increase the number of clinical attachments under this diploma, so GPs can get more experience in handling mental patients.

The latest batch of 24 GPs graduated two weeks ago. Among them is Dr Low Kee Hwa, 55, who said he has recently been able to pick out more people with depression or anxiety disorders.

One example he gave was of a woman in her 60s who visited five months ago complaining of chest discomfort. But she was actually suffering from depression.

Sensing something amiss, he probed further. The patient broke down in tears and revealed how strained relationships with her children were causing her stress.

Said Dr Low: "I have observed that more patients are now more willing to talk about common mental issues. So it would be essential for GPs to be able to treat these conditions."

But seeing someone who is mentally ill can take three times as long as a consultation for simple ailments such as a cold, which can be done within 10 minutes.

Which is why Dr Low will sometimes ask the patient to return when the clinic is not so crowded.

Regular talks by health-care experts are also open to all GPs as some mental health conditions, such as dementia and depression, can be tricky to differentiate.

Dr Srinivasa Sastry Malladi of IMH's geriatric psychiatry department said these conditions commonly affect the elderly. But symptoms - problems with appetite, sleep, motivation and memory - can be very similar and may confuse doctors, he said. Dr Malladi, who recently gave a talk to 110 GPs on how to tell the two conditions apart, said it is vital that correct diagnoses are made even at the primary-care level.

On top of training, the GP partners are supported by a team of IMH case managers. They remind newly referred patients of their appointments with the GPs and contact the patients afterwards to find out about their experience.

Meanwhile, GPs can contact the case managers if they encounter problems, such as patients not keeping to their treatment. The doctors can also call a 24-hour hotline operated by IMH to consult its specialists.

Another safeguard for the patients is that they are referred to the care of GP partners only if they are stable, said Dr Goh. This means they have not been hospitalised for the past six months and require similar medication each time.

This story was first published in The Straits Times on April 5, 2013

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