A first-hand experience of attending primary care with mental health issues

Andy first sought help after he collapsed at work - he had been experiencing significant stress for a number of months; his sleep was affected, he was using food as a way of coping and had taken up smoking.

He thinks being a male played a role in not seeking help. He felt he had to deal with his own problems and not complain, that other people had real problems to deal with and therefore he should ‘man up’. Language that surrounds mental health like ‘self-care’ and being ‘in touch with your feelings’ didn’t resonate with him and made asking for help a challenge. It was only when his physical health was affected that he felt more prepared to confront what he was experiencing. The stigma of talking about mental health doesn’t affect him anymore, but it does affect many boys and men and it’s something that needs to be considered by health care professionals who are hoping to encourage males to seek help.

Andy had recently started a new job and was afraid his new employer wouldn’t think he was up to the role. His role involved working with young people and he had this idea that he had to be a strong role model for them. In fact, a recent study by the University of Warwick found that over two thirds of employees didn’t tell their employer that they were struggling. A lot of people believe that nothing’s going to be done and nothing can be done, so what’s the point in raising it.

When Andy first attended primary care, he was not open about how he was feeling. It was easier to limit the disclosure to the fact that he had collapsed, nothing else. No one asked follow-up questions, so the focus was limited to the immediate issue of the collapse. It was important to rule out underlying medical issues…

It was a complex journey with Andy continuing to struggle. His mental health deteriorated and he began to experience suicidal thoughts. Thanks to the intervention of a friend, he did go back to his GP surgery. It was rather formal and brisk, with anti-depressants being offered as the solution rather than a range of options. He didn’t feel he was told what the side effects would be and that initially caused a loss of trust. As time went on, however, Andy did go back and talk more openly about his mental health.

Take the time to listen. All of Andy’s most positive interactions have been with people who have listened and treated him as an individual and taken the time to reassure him.

Don’t be afraid to ask more direct questions. If the person had asked Andy specifically whether he was considering taking his own life, it would have taken away a huge amount of the pressure that was on him to take that step. It would have normalised it and reassured him that if he had said he was feeling like this, they wouldn’t be shocked or overwhelmed, they would offer him solutions. It makes people feel less trapped and reassured.

The most positive experiences were when he felt reassured that his feelings were valid. The medical side is vital – having a level of competence and confidence is really helpful – but actually having someone there actively listening, a person-centred response, non-judgemental, is key.

Offer hope - but offer realistic and reasonable expectations. When Andy was sent out with antidepressants, he naively thought all his problems were over, but when he experienced side-effects and didn’t instantly feel happy, that led to disillusionment.

Be kind, calm and reassuring. Recognise that mental health recovery is a journey and much more likely to progress positively if you have people in your life who are offering that sense of hope.

Listen to what your patient says and what they feel will help. They are the experts in their own experience and it’s important that the patient’s voice is heard.