Mental Health (MH) in Primary Care
Mental Health (MH)
Mental Health is divided into Psychiatry and GP (community) teaching. As part of the Health of the Older Person, Ophthalmology, Oncology, Psychiatry & ENT (HOPE) module students spend 1 half day in General Practice (groups of 4-6 students) to learn about MH from a primary care perspective. They also take part in a full-day Mental Health in Primary Care workshop on campus. Teaching takes place on any weekday except for Wednesdays and over a four-week placement. There are are six placements in an academic year.
Aims
- Acquire knowledge surrounding common mental health presentations and conditions in primary care
- Gain some experience in terms of recognising, diagnosing and managing mental health conditions in primary care and an understanding in which circumstances an onward referral to Psychiatry may be required
- Develop the ability to take a holistic view of the patient, with an awareness of the broader physical, psychological and social issues.
Course content
Mental Health in the community placement content is divided into core and optional topics below. However, we recommend that at least 2 of the optional topics ( e g dementia and/or depression in the older person; alcohol and/or drug abuse) are also covered to allow a broader learning experience.
Core Topics
- Psychological morbidity in the community and somatic presentations
- Anxiety and depression
Optional Topics
- Alcohol and drug abuse
- Dementia and depression in the older person
- Eating disorders
- Psychosis
Structure of hospital psychiatry teaching
All students have nine weeks of psychiatry in their fourth year, split into 4 weeks on a general adult psychiatry firm and 4 weeks on a specialist firm (which ranges from child and adolescent disorders through to old age psychiatry). These two blocks are incorporated into a psychiatry, neurology and ophthalmology teaching programme; all students will have 4 weeks of neurology and 1 week of ophthalmology in the remaining time.
The students' hospital experience in psychiatry and the type of patients they see can vary greatly, as there is a large number of different firms that they may be attached to. The amount of formal 'clerking' of patients and case presentation that they do during their hospital firms can be limited. Some students may have an opportunity to do community outreach work with the consultant psychiatrist they are attached to, especially those attached to old age firms, where home visits are more likely. In general, though, students rarely meet patients with common mental disorders, unless these are very severe or are complicated by dual diagnosis.
Core teaching programme
Students have core teaching all day every Monday and some Tuesdays. This is arranged as a series of 'Problem-Based Learning' modules, which are based around problem scenarios such as 'the sad patient' or 'the confused patient'. In the first week of their firm they are all taught psychiatric history taking and Mental State Examination, using videos. The modules are then arranged so that they get teaching on depression and schizophrenia early on in the programme.
General Practice teaching structure
Students attend practices across London in groups of 2-6, where they have 1 session of dedicated small group teaching with GP tutors. This is arranged as 1 half-day session, and students may be at the beginning or the end of their psychiatry attachment. You will therefore find that students' level of knowledge and experience of psychiatry may vary when they come to your practice. We try and match GP practices to particular hospital firms to give a more consistent experience, but this is not always possible. Attendance of GP attachment is compulsory for all students.
Overall structure
Our evaluations have shown that students like teachers to discuss the subject first, move on to seeing a patient, and then have a final, more clinically orientated discussion. As noted earlier, they have relatively few opportunities to get structured feedback on either their history taking skills or case presentations and so they value this highly.
The 'patient contact' has consistently been rated as the most positive aspect of their GP psychiatry attachments. Therefore we expect GP tutors to invite patients with common mental health problems to meet students during these sessions. Students should be given opportunities to take full psychiatric histories from patients either singly or in pairs, to receive feedback on this individually and to discuss difficult management issues.
Learning objectives
- To understand the range of common mental health problems in the community and their detection, and recognising the factors that help and hinder this process
- To understand the potential overlap between physical, psychological and social morbidity
- To be more confident in undertaking focused psychiatric assessments of common mental health problems in Primary Care
- To be able to apply management strategies for common mental health problems in an integrated manner, considering the person in their whole context
- To understand the perspectives of both patients and carers of living with mental health problems
Attendance
Please note that attendance of all community-based teaching is compulsory and will be monitored as part of your firm assessment.
Patients are usually asked specially to attend for your teaching sessions so, if for any genuine reason you are unable to attend, it is essential that you email pcphmeded@ucl.ac.uk as soon as possible, and also contact the practice that is expecting you. You also need to complete the Absence Report and Leave Request Form.
Feedback
Please ensure you provide feedback on mental health teaching when emailed about this subsequent to the placement.
Any queries
If you have any questions about your Mental Health GP placement or workshop, please contact pcphmeded@ucl.ac.uk
For further information students should refer to the following:
By the end of the Mental Health in the Community placement, the students should be able to:
- Identify common mental health problems in the community and describe factors that help and hinder the process of presentation and identification
- Complete a full General Practice-orientated psychiatric assessment of a person with a common mental disorder, including a focused mental state examination
- Apply management strategies in an integrated manner considering the person in their context rather than only by their diagnosis
- Communicate effectively with adults with mental health problems
- Show understanding of both patient and carer perspectives of living with a mental health problem
Attendance of General Practice sessions is compulsory. Students are told that should exceptional circumstances arise, and they are unable to attend a placement, they should immediately inform PCPH Administration team pcphmeded@ucl.ac.uk and the practice which is expecting them.
If a student fails to attend without prior warning, please email pcphmeded@ucl.ac.uk as soon a possible.
We do not usually consider it appropriate for students who are suddenly unwell, or unfit to attend, to inform you of this via another student. If this happens, please let us know.
Concerns about studentsIf you have any concerns of a pastoral or educational nature about any students, please take a look at the Medical School's Concern over Professional Behaviour policy, and contact pcphmeded@ucl.ac.uk.
Further information:
UCL Medical School A-Z of Policies and FAQs