A GP's perspective on Mental Health Referrals

South Africa

The information provided below is intended to provide basic information about mental health medications. It is not a complete source for all medications available and should not be used as a guide for making medical decisions.

As a GP I am often the first point of call for people who are experiencing symptoms of anxiety, depression or both. Typically, my approach to their management is to create a foundation based on therapy and to add medication to this as needed. Each case is handled on its own presentation and sometimes therapy alone is the right course and for others we need to start medications relatively soon and combine it with therapy. Whatever the mode of treatment, I find that patient compliance is best if the treatment recommendations are explained to them from the very beginning with a focus on their expectations of therapy and explaining the potential side effects of medications. 

I spend a lot of time talking to patients about therapy and preparing them to utilise the space in the best possible way. It is common for me to hear people’s doubts and misconceptions. Many patients wonder what a therapist can do for them and they often think that a therapist will give them a solution to their problems. Some people can be quite dismissive and think that all a therapist does is sit there and ask, ‘how does that make you feel?’. I explain that therapists help people to discover what is happening to them internally- to gain insights into their thoughts, feelings and behaviours. I explain that they may have emotional triggers from childhood that compound current stressors and a therapist can help you to understand those. Many people are also afraid that going to a psychologist means that they are ‘crazy’ or that their difficulties are severe. I challenge these ideas and tell them how all kinds of people can benefit from therapy. I also prepare them for the fact that therapy is not a quick fix, but rather a process that takes time, but that finding the therapist who is right for them is central to a successful process. I find that explaining the process to my patient allows for a more positive experience in therapy and successful relationship development between patient and therapist and therefore, a more successful treatment.

With medication, patients are very concerned regarding medications that once you start you can never stop or that the medications themselves are addictive and they will be hooked to them. Once again spending the time to explain this to my patients leads to far better patient compliance. Some medications do have an addictive element and this needs to be addressed realistically. 

When discussing a mutual patient with a psychologist I prefer written or telephonic feedback. Mostly, I am looking to hear how the patient is progressing and if there is anything I can do to help them. I am particularly interested in the psychologist’s feedback if we are considering stopping medication or lowering their dose. I do not need to know the details of their sessions or other information that does not impact on my treatment.

When a patient presents with depression or anxiety I often start treatment myself, but I refer to a psychiatrist if the symptoms are severe, the patient is suicidal or the presentation is complicated. I may also need the psychiatrist to do an assessment, for example, for ADHD. Once a patient is with a psychiatrist I rarely have contact with the psychiatrist, but I may take over managing medication if the patient is stable. 

In the next few weeks I will upload a series of articles about the various psychiatric drugs, how they are used, common side effects and how people respond to them.

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