‘In the varied topography ofprofessional practice, there is ahigh, hard ground of technicalrationality which overlooks aswamp where problems are messy,confusing and incapable oftechnical solution.
The difficulty is that the problems ofthe high ground, however great theirtechnical interest, are often relativelyunimportant to clients or to the largersociety, while in the swamp are theproblems of the greatest humanconcern’ Donald Schon - Bostonian MIT 1984
In the swamp...people have needsand problems…….before they have diagnoses
In the swampy world of primary care... The GP and School Nurse are two of the most favoured health staff by young people In 1 of 3 teenage consultations with the GP the young person has a diagnosable mental health problem Young people present to the GP with minor physical health presentations often brought in by a parent Primary can offer continuity & longitudinal care
Generalist practice is …“decision-making which is person-, not disease-focused, which is continuous and not episodic, which integrates the biographical and the biotechnical knowledge … all with a view to supporting health as a resource for living and not an end in itself.” Joanne Reeve, NIHR Clinical Scientist in Primary Care, University of Liverpool
The GP service & consultation unpickedFor a young person…what is unique about the GP service?
For a youngperson…what is uniqueabout the GPservice?
NO ELIGIBILITY CRITERIA / YOU DON’T NEED A DIAGNOSIS / NO TRANSITIONSUnique… Access to help through routes that young people already use LOCALLY Use of physical health to engage young person Longitudinal care from early childhood onwards – episodic care Early detection & intervention with other family members. Early medical risk assessment GP commissioning
Youth mental health services- dont forget the GP! (and GP commssioners – don’t forget youth mental health) CWMT GP toolkit. www.cwmt.org.uk RCGP Endorsed Ways to engage Ways to support - GP case studies - GP & team consultation tools
Working with parentsDr Maryanne Freer firstname.lastname@example.org
...consent and confidentialityDr Maryanne Freer email@example.com
Early detection & assessmentMental health consultation framework Life Situation Altered thinking (ICE) Altered physical Altered emotional symptoms feelings Altered behaviour
CWMT training available • Train the trainers: - For people with a training and partnership role - Ways to engage, partner & train primary care in young people mental health • One off, local, primary care training in young people mental health - to get the ball rolling - to get others involved & support further partnership working