Written evidence submitted by Dr Faraz Mughal, academic GP, School of Medicine, Keele University (CYP0047)
Thank you for reading this document.
I am an NHS GP and NIHR Doctoral Fellow at Keele University funded to improve the care young people receive for self-harm in primary care. I have clinical expertise in young people’s mental health in primary care and am an RCGP clinical advisor and representative. I represented the RCGP at the 2017 Green Paper stakeholder consultations. I sit on the current NICE self-harm clinical guideline development committee.
I will focus on the following three main areas which I tackle in order below:
1) Improving access to mental health services
2) Wider system changes
3) Tackling self-harm and suicide in young people
On the ground in general practice, there appears to be some progress in improving access to specialist services for young people such as the Forward Thinking Birmingham (FTB) model for 0-25 year olds, but still limited to young people in Birmingham only from the West Midlands. These integrated holistic services which remove the transition barrier need ongoing rigorous research evaluation to ensure they are adapted, refined and improved to the needs of young people. This needs to be done in partnership with young people and families. I am concerned services such as FTB may struggle to be sustained moving forward if ongoing evaluation does not keep on improving such services.
NHS Digital data has shown that young people present to GPs the most out of all healthcare professionals for common mental health and emotional problems. This may well now be more serious given the impact of COVID-19 on young people’s mental health. It is unrealistic for GPs to refer all young people needing support for mental health concerns to services outside of primary care. Young people and families have repeatedly stated that they want care and treatment as close to home as possible, without travel nor needing to wait on waiting lists. Young people and families have ongoing trusting relationships with general practices and GPs, and so, GPs need much more support to provide mental health care for young people in consultations and in primary care. This can be facilitated through the young people’s IAPT programme.
Early intervention is crucial in young people’s mental health. We need to move to a public mental health approach where intervention and prevention is priority and firmly funded over treatment of mental health conditions. Treating conditions is costly to the young person, their family, society, and the NHS. Within a complex system model, general practice within primary care must be priority.
90% of patient contacts occur in general practice, and this is an opportunity that cannot be missed - to intervene early for young people’s mental health and wellbeing. There is a wealth of recent evidence now highlighting the benefits to patients of continuity of GP care, including lower morbidity and mortality.
Self-harm in young people is a growing concern in general practice and primary care. Recent GP electronic patient record data has shown that levels of self-harm in young people recorded in general practice have been rising. Young people who self-harm seek help from GPs the most out of all healthcare professionals in the NHS. One way therefore to tackle increasing rates of self-harm, and thus reduce deaths by suicide in young people, is to invest in self-harm resources and services specific to primary care.
Young people who have harmed themselves have told us in our research that they want more support and care from their GP and do not want to travel or be referred for treatment. A recent evidence synthesis I led and published in the British Journal of General Practice found the role of the GP in self-harm management to include frontline assessment, treatment and ongoing management for young people who self-harm. A primary care approach with focus on general practice, for the identification of and reduction in repeat self-harm is crucial to suicide prevention in young people, and I feel, will result in the fastest progress in tackling concerning rates of self-harm in young people.
February 2021