Mental health toolkit

Introduction

Around 40 per cent of GP appointments now involve mental healthRC (Mind 2018) and complexity is increasing with rising referral to secondary care (BMA 2017). Despite this, 90% of mental conditions are exclusively cared for in primary care (NHS England, 2017). The resources here will assist you with early assessment, recognition, management and support of patients with mental health difficulties and those close to them. 

More information on the RCGP’s perspective on the provision of mental health care in primary care can be found in the RCGP Position Statement (2017) (PDF file).

Each section of the toolkit is divided into four sections, helping you find the information you need easily:

• Guidelines: Guidelines from a variety of national and international sources are collated for quick access to the latest evidence-based practice. 
• Useful resources: This is a list of non-guideline resources that practitioners may find helpful in the clinical assessment and management of patients with mental health conditions.
• Patient and carer information: A collection of resources, information and support that it might be helpful to signpost your patients and their families/carers to.
• Further reading: This highlights sources of further learning -  these are available in a variety of formats, including elearning, academic blogs, podcasts and reading.

Child and adolescent mental health

Guidelines

ADHD NICE Clinical Knowledge Summary – ADHD (2021) - Attention deficit hyperactivity disorder (ADHD) is a behavioural syndrome characterised by hyperactivity, impulsivity, and inattention. It starts in childhood. Information on features, recognition, diagnosis and management options are covered in this knowledge summary.

Autism NICE Clinical Guideline [170] - Autism spectrum disorder in under 19s: support and management (updated 2021) - This guideline covers children and young people with autism spectrum disorder (across the full range of intellectual ability) from birth until their 19th birthday. It covers the different ways that health and social care professionals can provide support, treatment and help for children and young people with autism, and their families and carers, from the early years through to their transition into young adult life. It should be used alongside the Autism spectrum disorder in under 19s: recognition, referral and diagnosis and Autism spectrum disorder in adults: diagnosis and management guidelines.

Autism NICE Quality Standard [QS51] – Autism (2014) - This quality standard covers health and social care services for adults, young people and children with autism. It includes assessment and diagnosis of autism spectrum disorders, and care and support for people diagnosed with an autism spectrum disorder.

Anxiety NICE Quality Standard [QS53] – Anxiety disorders (2014) - This quality standard covers identifying and managing anxiety disorders in adults, young people and children in primary, secondary and community care. It covers a range of anxiety disorders, including generalised anxiety disorder, social anxiety disorder, post-traumatic stress disorder, panic disorder, obsessive–compulsive disorder and body dysmorphic disorder.

Autism NICE Clinical Guideline [CG128] - Autism spectrum disorder in under 19s: recognition, referral and diagnosis (updated 2017) - This guideline covers recognising and diagnosing autism spectrum disorder in children and young people from birth up to 19 years. It also covers referral. It aims to improve the experience of children, young people and those who care for them.

Autism SIGN Guideline 145 -Assessment, diagnosis and interventions for autism spectrum disorders (2016) - The guideline provides recommendations for best practice in the screening, surveillance, diagnosis, assessment and clinical interventions for children and young people with ASD. It also incorporates evidence and recommendations on assessment, diagnosis and interventions for adults with ASD.

Depression NICE Clinical Knowledge Summary – Depression in children (2020) - This summary looks at how depression may present in children and adolescents and how to stratify it into mild, moderate or severe. It offers guidance on watchful waiting, primary care interventions and referral thresholds.

Depression NICE Guideline [NG134] – Depression in children and young people: identification and management (2019)  - This guideline relates to children and young people aged 5-18. It takes a stepped care approach, with steps 1 and 2 relevant to the role of primary care.

Student mental health NICE Clinical Knowledge Summary – Mental Health in Students (2020) - This CKS topic covers the identification, assessment, and management of mental health problems in students.

OCD and BDD NICE Clinical Guideline [CG31] – Obsessive-compulsive disorder and body-dysmorphic disorder: treatment (2005) - This guideline covers recognising, assessing, diagnosing and treating obsessive-compulsive disorder and body dysmorphic disorder in adults, young people and children (aged 8 years and older). It includes recommendations on how families and carers may be able to support people with either of these conditions, and how they can get support for themselves.

PTSD NICE Guideline [NG116] - Post-traumatic stress disorder (2018) - This guideline covers recognising, assessing and treating post-traumatic stress disorder (PTSD) in children, young people and adults. It aims to improve quality of life by reducing symptoms of PTSD such as anxiety, sleep problems and difficulties with concentration. Recommendations also aim to raise awareness of the condition and improve coordination of care.

Self-harm NICE Quality Standard [QS34] – Self-harm (2013) - This quality standard covers the initial management of self-harm and the provision of longer-term support for children and young people (aged 8 to 18) and adults (aged 18 and over) who self-harm.

Self-harm NICE Clinical Guideline [CG133] – Self-harm in over-8s: long term management (2011) - This guideline covers the longer-term psychological treatment and management of self-harm in people aged 8 and over. It aims to improve the quality of care and support for people who self harm and covers both single and recurrent episodes of self-harm.

Social anxiety NICE Clinical Guideline [CG159] – Social anxiety disorder: recognition, assessment and treatment (2013) - This guideline covers recognising, assessing and treating social anxiety disorder (also known as ‘social phobia’) in children and young people (from school age to 17 years) and adults.

Useful resources

Early Detection of Emerging Psychosis (PDF file, 564 KB) - This factsheet offers guidance for GPs on recognition of early psychosis – the most common age for development of psychosis is 16-30, but 5% are 15 or younger.

Hub of Hope - A directory of local services for support with a wide variety of mental health and related issues.

Living Life to the Full – Young People - This is a suite of online life skills for young people, helping them to help themselves. They include modules, online books, worksheets and videos.

RCGP Top Tips – Anxiety in Children and Young People - This succinct guide is written to support clinicians and primary health professionals when caring for children and young people suffering from anxiety

RCGP Top Tops – Suicide in Children and Young People - This document offers some suggestions specifically about how to assess and manage suicide risk in a consultation, acknowledging that more detailed mental health assessment may need to take place over multiple consultations and with input from other services.

RCGP Top Tips – Self-harm in Children and Young People - Self-harm is a mode of communication which expresses the young person’s sense of emotional distress often exacerbated by frustration or a sense of isolation. This short document offers some top tips in the approach to self-harm.

Patient and carer information

ADDISS - ADDISS provides a wide range of information and resources about attention deficit hyperactivity disorder to parents, sufferers, teachers and health professionals.

Alumina - Alumina is a free, online 7 week course for young people struggling with self-harm. Each course has up to 8 young people, all accessing the sessions from their own phones, tablets or laptops across the UK. It is run by trained counsellors.

Autism Alliance - This is a network of 17 charities across the UK. It works to support, provide information, research and provide training about childhood and adult autism.

Banardos - This site offers support to young people on a variety of topics, including training, employment, LGBTQ+ issues and a directory of local services.

Charlie Waller Trust - This charity helps young people to understand their own mental health, equips them to support themselves and those around them, and to empowers them to talk more openly about the subject. They do a lot of outreach work with families, schools, colleges, universities, and employers.

Childline - Childline is available to anyone under 19 and offers telephone, email and counsellor webchat support 24/7.

Child Autism UK - Support, advice and services for children with autism.

Hampshire Child and Adolescent Mental Health Services – Personal coping plan - Download instructions on how to make a personal crisis and coping plan for a child or young person.

Home Advisor - Creating the optimal living environment for a child with ADHD.

Mental Health Foundation - This page answers several common questions about children and young people’s mental health and signposts to various sources of support.

National Autistic Society - This site offers advice on a wide range of issues affecting autistic people and their families.

NHS England – Urgent Mental Health Helpline - This link takes you to a site where urgent mental health help can be accessed 24/7. This may be via 111 or some areas have dedicated numbers.

NSPCC - The NSPCC has advice for parents/carers on how to manage concerns about their children’s mental health. It includes self-harm, bullying, drugs and alcohol. There is also a mindfulness guide for families.

OCD UK - This charity work for children and adults, providing advice, information, and support services for those affected by OCD.

Papyrus UK - This charity is focused on suicide prevention in children and young people. There are crisis contacts, information for parents/carers and also for professionals on how to support young people who are struggling with their mental health, especially if they are experiencing suicidal ideation.

PDA Society - Pathological demand avoidance (PDA) is considered to be part of the autistic spectrum involving the avoidance of everyday demands and the use of ‘social’ strategies as part of this avoidance. The website has an introduction to what PDA is and also some resources for individuals, parents and professionals.

Royal College of Psychiatrists - This section of their website contains information for young people, parents and carers about young people’s mental health.

Sibs - A charity supporting brothers and sisters of disabled children and adults.

SupportLine - SupportLine describe their work as offering confidential emotional support to children, young adults and adults by telephone, email and post. They aim to develop healthy, positive coping strategies, inner strength and increased self esteem to encourage moving forward with life.

Sussex Partnership NHS Foundation Trust – How to make a crisis coping plan with a young person - This is a two minute film made by Sussex Partnership NHS Foundation Trust and describes how to make a crisis coping plan. It is designed to be watched by a carer with or without the young person present.

The Children’s Society - This link is to a page for young people, designed to help them with their emotional wellbeing and provide information in an accessible way.

The Mix - This organisation offers essential support to under-25s, including mental health support.

Young Minds - Young Minds is a charity who work with children, parents, carers and professionals to support the mental health of young people. There are links from the home page for further information and support for all of these groups.

Further information and reading

MindEd - MindEd is an online learning and advice resource for anyone interested in, or concerned about, the mental health of children and teenagers. There are sections for both professionals and families. It is free to access.

Mughal, F., Babtunde, O., Dikomitis, L. et al. Self-harm in young people: the exceptional potential of the general practice consultation. BJGP 2019; 69 (681): 168-169 - This paper summaries the role of practices and practitioners in identifying issues and supporting children and young people to engage in primary care services.

RCGP eLearning Module - Autistic Spectrum Conditions - This course comprises a set of three modules which describe the identification and management of ASCs in children, young people and adults.

RCGP eLearning Module – Child and adolescent mental health - This elearning course on Child and Adolescent Mental Health enables you to recognise the most common presentations of mental health difficulties in children and young people. Cases and discussion are used to illustrate the key points, in particular focusing on mood and behavioural problems.

RCGP eLearning Module - Consultation with young people with mental health problems: a practical guide - This course considers consultations in primary care with young people with mental health problems. Common presentations are considered, including physical symptoms, and the recognition of the existence of a mental health problems is discussed.

RCGP Position Statement – The Role of the GP in Caring for Gender Questioning and Transgender patients (2019) - GPs are most often the first point of contact with the health care system for individuals questioning their gender. In some cases, GPs can be the first people they confide in about their gender identity or uncertainties about their gender identity. General practice plays a vital role in ensuring these patients receive the care they need. This document offers more information about the GPs role and approach.

RCGP Screencast – Children’s mental health - In this short screencast risk factors for mental illness are discussed, and a framework described for what to address during such consultations.

General adult mental health

Guidelines

Anxiety NICE Clinical Guideline [CG113] - Generalised anxiety disorder and panic disorder in adults: management (updated 2019){This guideline covers the care and treatment of people aged 18 and over with generalised anxiety disorder (chronic anxiety) or panic disorder (with or without agoraphobia or panic attacks). It aims to help people achieve complete relief of symptoms (remission), which is associated with better functioning and a lower likelihood of relapse.

Anxiety NICE Quality Standard [QS53] – Anxiety disorders (2014){This quality standard covers identifying and managing anxiety disorders in adults, young people and children in primary, secondary and community care. It covers a range of anxiety disorders, including generalised anxiety disorder, social anxiety disorder, post-traumatic stress disorder, panic disorder, obsessive–compulsive disorder and body dysmorphic disorder.

Bipolar disorder NICE Clinical Guideline [CG185] – Bipolar disorder: assessment and management (updated 2020){This guideline covers recognising, assessing and treating bipolar disorder in children, young people and adults. The recommendations apply to bipolar I, bipolar II, mixed affective and rapid cycling disorders. It aims to improve access to treatment and quality of life in people with bipolar disorder.

Common mental health problems NICE Clinical Guideline [CG123] – Common mental health problems: identification and pathways to care (2011){This guideline covers care for people aged 18 and over with common mental health problems, with a focus on primary care. It aims to improve access to services for adults and how mental health problems are identified and assessed, and makes recommendations on local care pathways.

Depression NICE Clinical Guideline [CG90] - Depression in adults: recognition and management (2009){This guideline covers identifying and managing depression in adults aged 18 years and older, in primary and secondary care. It aims to improve care for people with depression by promoting improved recognition and treatment. NB New guideline due for publication in May 2022

Depression NICE Clinical Guideline [CG91] - Depression in adults with a chronic physical health problem: recognition and management{This guideline covers identifying, treating and managing depression in people aged 18 and over who also have a chronic physical health problem such as cancer, heart disease or diabetes. It aims to improve the care of people with a long-term physical health problem, which can cause or exacerbate depression.

Depression NICE Quality Standard [QS8] – Depression in adults{This quality standard covers the clinical assessment and management of depression in adults (aged 18 and over). It includes adults with persistent subthreshold depressive symptoms or mild, moderate or severe depression, including those who also have a chronic physical health problem.

OCD and BDD NICE Clinical Guideline [CG31] – Obsessive-compulsive disorder and body-dysmorphic disorder: treatment (2005){This guideline covers recognising, assessing, diagnosing and treating obsessive-compulsive disorder and body dysmorphic disorder in adults, young people and children (aged 8 years and older). It includes recommendations on how families and carers may be able to support people with either of these conditions, and how they can get support for themselves.

Personality disorders NICE Clinical Guideline [CG77] - Antisocial personality disorder: prevention and management (updated 2013){This guideline covers principles for working with people with antisocial personality disorder, including dealing with crises (crisis resolution). It aims to help people with antisocial personality disorder manage feelings of anger, distress, anxiety and depression, and to reduce offending and antisocial behaviour.

Personality disorders NICE Clinical Guideline [CG78] - Borderline personality disorder: recognition and management (2009){This guideline covers recognising and managing borderline personality disorder. It aims to help people to manage feelings of distress, anxiety, worthlessness and anger, and to maintain stable and close relationships with others.

Personality disorders NICE Quality Standard [QS88] - Personality disorders: borderline and antisocial (2015){This quality standard covers assessing and managing borderline and antisocial personality disorders.

PTSD NICE Guideline [NG116] - Post-traumatic stress disorder (2018){This guideline covers recognising, assessing and treating post-traumatic stress disorder (PTSD) in children, young people and adults. It aims to improve quality of life by reducing symptoms of PTSD such as anxiety, sleep problems and difficulties with concentration. Recommendations also aim to raise awareness of the condition and improve coordination of care.

Self-harm NICE Quality Standard [QS34] – Self-harm (2013){This quality standard covers the initial management of self-harm and the provision of longer-term support for children and young people (aged 8 to 18) and adults (aged 18 and over) who self-harm.

Self-harm NICE Clinical Guideline [CG133] – Self-harm in over-8s: long term management (2011){This guideline covers the longer-term psychological treatment and management of self-harm in people aged 8 and over. It aims to improve the quality of care and support for people who self harm and covers both single and recurrent episodes of self-harm.

Social anxiety NICE Clinical Guideline [CG159] – Social anxiety disorder: recognition, assessment and treatment (2013){This guideline covers recognising, assessing and treating social anxiety disorder (also known as ‘social phobia’) in children and young people (from school age to 17 years) and adults.

Useful resources

Early Detection of Emerging Psychosis (PDF file, 564 KB) - This fact sheet offers guidance for GPs on recognition of early psychosis – the most common age for development of psychosis is 16-30, but 5% are 15 or younger.

General Anxiety Disorder-7 (GAD-7) - This screening tool is useful for assessing any potential anxiety disorder and generating a score which can be helpful in assessing treatment response.

Hub of Hope - A directory of local services for support with a wide variety of mental health and related issues.

Patient Health Questionnaire-9 (PHQ-9) - The PHQ-9 is helpful as a screening tool as well as quantifying depressive symptoms in the assessment and monitoring of the condition.

National Centre for Mental Health - They offer a ‘Medication Handy Chart’ which can be used as a quick reference guide for clinicians when discussing mental health medication with patients. The chart contains information on hundreds of common mental health medications, including their use, effects and side effects. Information is impartial and has been written and checked by expert pharmacists. It can be ordered by emailing info@ncmh.info.

Patient and carer information

Andy’s Man Club - Mutual support, facilitated talking groups every Monday for men who have faced or are facing a tough time.

Anxiety UK - Anxiety UK delivers a variety of services, including therapy, a helpline, courses, groups and webinars.

Bipolar Education Programme Cymru - BEPC is a psychoeducation programme that aims to improve the quality of life for people with bipolar disorder. It enables individuals to better manage their condition by understanding the symptoms of bipolar disorder, identifying their triggers and monitoring their mood to help them stay as well as possible. It includes a useful postcard on helping people to recognise illness and stay well.

CALL Helpline Wales - They can be contacted for mental health support and advice via both telephone and text message.

CALM - The Campaign Against Living Miserably movement predominantly focuses on support for men, but this is not exclusive. There are a multitude of help guides on their site, as well as a helpline and webchat.

Living Life to the Full - Free, CBT-based, online courses covering low mood, stress and resilience.

Mental Health Foundation – Rethinking Rest  - The Rethinking Rest Guide looks at the different types of rest, why rest is important and gives suggestions on how to achieve good quality rest for the whole body, mind and soul.

Mind - The website has lots of information but additionally there is an information line (0300 123 3393) or email info@mind.org.uk

There is a legal line (0300 466 6463)  for free advice on mental health related law, including mental capacity, community care and discrimination.

Mind – Talking to your GP about your mental health - This is the ‘Find the Words’ outreach by Mind designed to support people in talking to their GP about their mental health. Information is available in a short animation or a downloadable format in a variety of languages.

NHS England - The NHS website has a multitude of resources, including self-quizzes for anxiety and depression, dealing with life events and self-help strategies.

NHS Inform - NHS inform is Scotland's health information service. It offers quality assured health and care information via a website and phone service. This section is on identifying, treating and managing mental health problems and disorders. It includes self-help guides on a wide variety of conditions.

NI Direct - Resources for people affected by mental health in Northern Ireland.

No Panic - This charity has a variety of information on anxiety and panic attacks, as well as recorded breathing exercises and a panic helpline.

OCD UK - This charity work for children and adults, providing advice, information, and support services for those affected by OCD.

Penumbra - Penumbra supports adults and young people in Scotland with mental health problems. They offer services that provide practical and emotional support.

Quarriers - This Scottish charity specialise in supporting adults affected by learning disabilities,     complex physical disabilities, acquired brain injury and autism.

Reading Well for Mental Health - This is part of the ‘books on prescription’ scheme and p rovides helpful information and support for managing common mental health conditions, or dealing with difficult feelings and experiences. Some books also include personal stories from people who are living with or caring for someone with mental health needs.

Recovery College Online - Providing a range of online educational courses and resources to people who might be struggling with mental health issues, families, friends, mental health workers and anyone else who might be interested.

Royal College of Psychiatrists - Information for patients, carers, family and friends relating to mental health problems and disorders.

Rethink Mental Illness - The Rethink advice and information line (0808 801 0525) offers practical advice on treatments and life issues that may present challenges such as money or the judicial system. This support is also available via webchat or email at advice@rethink.org

There is also a section on how to access mental health support in general.

Scottish Association for Mental Health - This section on going to see your GP helps patients understand how they can communicate effectively and make the best of their appointment, recognising that seeking help for mental health conditions can be difficult.

Self-Compassion - Information on self-compassion and guided practices and exercises.

SupportLine - SupportLine describe their work as offering confidential emotional support to children, young adults and adults by telephone, email and post. They aim to develop healthy, positive coping strategies, inner strength and increased self esteem to encourage moving forward with life.

Women’s Wellbeing Club - Women’s Wellbeing Club is a peer to peer community support group  run for women by volunteers at a variety of sites across England and Scotland.

Further information and reading

British Association for Psychopharmacology – Insomnia (2019) - This detailed guideline from the BAP contains useful snippets for primary care (especially pages 5-6 of the PDF, and the text in bold throughout the document) on the assessment and treatment options – including non-pharmacological measures – of sleep problems.

British Medical Journal – Early Psychosis for the Non-Specialist Doctor (2017) BMJ 2017;357:j4578 - This article, podcast and infographic illustrate what you need to know as a GP in the early detection and management of psychosis.

DeSTRESS Project - These materials aim to support GPs working with low-income patients experiencing mental distress that is largely psychosocial in nature.

RCGP Top Tips – Insomnia - The RCGP have produced a 'Top Tips: Insomnia in Adults' leaflet to help clinicians and primary health professionals treat and manage insomnia in adults.

Recovery College Online - Providing a range of online educational courses and resources to people who might be struggling with mental health issues, families, friends, mental health workers and anyone else who might be interested.

University of Reading – Understanding Anxiety, Depression and CBT - This RCGP accredited course is designed to help improve your understanding of depression and anxiety and find out more about an effective and evidence-based treatment: CBT.

Older adults

Guidelines

Care Homes NICE Quality Standard [QS50] - Mental wellbeing of older people in care homes (2013) - This quality standard covers the mental wellbeing of older people (aged 65 and over) receiving care in care homes. It focuses on support for people to improve their mental wellbeing so that they can stay as well and independent as possible.

Delirium SIGN Guideline 157 - Risk reduction and management of delirium (2019) - This guideline provides recommendations based on current evidence for best practice in the detection, assessment, treatment and follow up of adults with delirium, as well as reducing the risk of delirium. The guideline applies to all settings: home, long-term care, hospital, and hospice.

Delirium NICE Guideline [NG103] – Delirium: prevention, diagnosis and management (updated 2019) - This guideline covers diagnosing and treating delirium in people aged 18 and over in hospital and in long-term residential care or a nursing home. It also covers identifying people at risk of developing delirium in these settings and preventing onset. It aims to improve diagnosis of delirium and reduce hospital stays and complications.

Delirium NICE Quality Standard [QS63] – Delirium in adults (2014) - This quality standard covers the prevention, diagnosis and management of delirium in adults (aged 18 and over) in hospital or long-term care settings.

Dementia NICE Quality Standard [184] – Dementia (2019) - This quality standard covers preventing dementia, and assessment, management and health and social care support for people with dementia

Dementia NICE Guideline [NG97] - Dementia: assessment, management and support for people living with dementia and their carers (2018) - This guideline covers diagnosing and managing dementia (including Alzheimer’s disease).

Dementia NICE Technology Appraisal [TA217] - Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (updated 2018) - This discusses assessment of dementia and the use of donepezil, galantamine, rivastigmine and memantine for treating Alzheimer's disease in adults.

Dementia NICE Guideline [NG16] - Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset (2015) - This guideline covers mid-life approaches to delay or prevent the onset of dementia, disability and frailty in later life. The guideline aims to increase the amount of time that people can be independent, healthy and active in later life.

Useful resources

Addenbrookes Cognitive Examination III (ACE-III) - A detailed memory assessment, enabling a breakdown of scores into attention, memory, fluency, language and visuospatial skills.

Alzheimer’s Society - Optimising treatment and care for people with behavioural and psychological symptoms of dementia - A best practice guide for health and social care professionals (2016) - This guide aims to provide evidence-based support, advice and resources to professionals caring for people with dementia who have behavioural and psychological symptoms. It has been designed to be a practical, informative tool, with an emphasis on alternatives to drug treatment, although these are also considered (page 22).

Devon Partnership NHS Trust - Pharmacological Management of

Severe Behavioural & Psychological Symptoms of Dementia (BPSD) (2019) - These guidelines by Devon Partnership NHS Trust have some very useful evidence-based advice on interventions for BPSD.

Hub of Hope - A directory of local services for support with a wide variety of mental health and related issues.

GPCOG - The Dementia Collaborative Research Centres have produced the General Practitioner assessment of Cognition (GPCOG) is a screening tool for cognitive impairment. It has been designed for primary care practitioners. It comprises a patient interview and an informant interview. This link is to the online version, but it is also available in printable format in several languages.

Mini Mental State Examination (MMSE) - This is the more detailed 30-point screening tool, commonly used in secondary care memory services.

Montreal Cognitive Assessment (MoCA) - A 10 minute, 30 point test which includes executive functioning and attention tasks, as well as language, memory and visuo-spatial skills designed for those scoring 24-30 on MMSE. It is free to use, but registration is needed. If you do not wish to do the online training in its administration then you can still use it but have to sign a disclaimer to say you are untrained.

Top Tips: Diagnosis and management of common mental health problems in older people. - A brief guide to the diagmosis and management of mental illness in older people – a summary of the content of the ‘Practice Primer’ but NHS England and NHS Improvement (see below).

Top Tips: Management of Depression in Older People: Why this is Important in Primary Care - The primary care management of depression in older adults is summarised in this document.

6-item Cognitive Impairment Test (6-CIT) - Developed by The Kingshill Research Centre, Swindon, this is a brief screening tool in primary care, although the scoring is more complicated than some other tools. It has high sensitivity and specificity rates and takes 3-4 minutes to complete.

Patient and carer information

Age UK - Age UK offer friendship services, both face to face and via telephone, to combat loneliness in older people. There is a wealth of information on dementia and depression/anxiety in later life. Practical advice and support is also available on a variety of life issues such as finding and arranging care, and support for carers.

Alzheimer’s Society - A list of resources for patients and carers with dementia is available here.

Carers Trust - This site helps carers find help, information and support local to them. It includes specific information about mental health caring.

Independent Age - This site helps people live well, keep active, addresses lonliness and discusses relationships in later life.

Men’s Sheds - These are community spaces for men to connect, converse and create. The activities are often similar to those of garden sheds, but for groups of men to enjoy together. They help reduce loneliness and isolation.

Mental Health Foundation - Information on changes in later life and how they may affect mental health. It includes a guide on how to look after your mental health in later life.

Mind - There is a legal line (0300 466 6463)  for free advice on mental health related law, including mental capacity, community care and discrimination.

Princess Royal Trust for Carers - This organisation helps people make plans in advance about what would happen to the person they care for should they unexpectedly become unwell themselves and not able to fulfil their caring role.

Public Health England – A Guide to Healthy Caring - This guide offers advice to carers on keeping well, recognising the strain that being a carer can bring.

Rethink Mental Illness – Carers Hub - This section of the website has all that carers need to know about looking after their dependent.

Royal College of Psychiatrists - Information for patients, carers, family and friends relating to mental health problems and disorders.

The Silver Line - This is a confidential help and advice line, available 24/7/365, and it also offers telephone friendship calls and facilitated groups.

10 Today - 10 Today is an exercise programme led by older people, for older people. It provides a series of easy and accessible 10-minute broadcasts, which can be done almost anywhere and at any time, in a group or alone, standing up or sitting down, and which can be adapted to different fitness levels. 10 Today aims to increase mental wellbeing and social interaction through group classes, whilst also improving physical activity.

Further information and reading

Alzheimer’s Society – Resources for professionals - This includes a link to refer people to Dementia Connect for tailored support from Alzheimer’s society. There are also educational materials on the site.

British Association for Psychopharmacology – Dementia (2017) - This consensus statement looks at the changes to classification of cognitive impairment and a detailed review of drugs for dementia.

Troya, M., Babtunde, O., Polidano, K. et al. Self-harm in older adults: systematic review. British Journal of Psychiatry, 214(4), 186-200 - This paper looks at the latest evidence and characteristics around self-harm in older people. It is discussed further in a podcast with Dr Elizabeth England and Professor Carolyn Chew-Graham.

NHS England, RCGP, Age UK Webinar: Detection and Treatment of Depression in Older People - This webinar explores how to improve the identification of mental illness in older adults. It discusses tips and issues around OPMH in primary care.

NHS England – Dementia diagnosis and management (2015) - This is a brief, pragmatic resource for GPs, and this version has summary notes and highlights to make it easy to use. It includes justification and support for making the diagnosis of dementia in primary care.

NHS England and NHS Improvement - Mental Health in Older People

A Practice Primer - To support GPs’ and primary healthcare professionals’ diagnosis and management of common mental health problems in older people, a comprehensive guide has been published by NHS England and NHS Improvement.

NICE - Antipsychotics in people living with dementia (2019) - This document summarises the evidence base on antipsychotics in people living with dementia. It is a key therapeutic topic that has been identified to support medicines optimisation rather than formal NICE guidance.

RCGP eLearning Module – Alzheimer’s dementia - This course updates learners on how Alzheimer’s disease is diagnosed and managed. The emphasis is on the GP’s role in prescribing and dealing with difficult symptoms such as loss of appetite, poor sleep, agitation and aggression.

RCGP/RCPsych Joint webinar: a collaborative case discussion with GPs and old age psychiatrists - The aim of the webinar was to offer the opportunity for participants from primary care and psychiatry to learn together. The panellists worked through a case (based on experiences of the webinar presenters) to illustrate the complexity of managing an older person with mental-physical comorbidity.

Perinatal and menstrual cycle mental health

Guidelines

NICE Clinical Guideline [CG192] Antenatal and postnatal mental health: clinical management and service guidance - This guideline covers recognising, assessing and treating mental health problems in women who are planning to have a baby, are pregnant, or have had a baby or been pregnant in the past year. It covers depression, anxiety disorders, eating disorders, drug- and alcohol-use disorders and severe mental illness (such as psychosis, bipolar disorder and schizophrenia).

Royal College of Obstetricians and Gynaecologists – Premenstrual syndrome, Management. (Green Top Guideline No 48) (2016) - This guideline reviews the diagnosis, classification and management of premenstrual syndrome. In addition, the evidence for pharmacological and non-pharmacological treatments is examined.

Useful resources

UK Drugs in Lactation Advisory Service (UKDILAS) - UKDILAS provides evidence based information on the use of drugs during the breastfeeding period.

UK Teratology Information Service (UKTIS)  - This site and offers information on the use of medication in pregnancy and is linked to ToxBase (which has more detailed reviews)

Patient and carer information

Action on Postpartum Psychosis - Action on Postpartum Psychosis is the national charity for women and families affected by postpartum psychosis and contains links to peer support services and patient information guides.

Best Use of Medicines in Pregnancy (BUMPS) - This website provides reliable, evidence-based, and accurate information about use of medicines in pregnancy, in the form of freely available patient information leaflets, written by the UK Teratology Information Service.

Breastfeeding Network - BfN endeavours to provide information to enable mothers to breastfeed their babies for as long as they wish and to provide information on the safety of medicines for each mother and baby pair.

Contact - Support for parents raising a child with additional needs or disabilities.

Cry-sis - Cry-sis offer support for parents with crying and sleepless babies. The website includes signposting to a helpline (08451 228 669) open until 10pm 7 days a week.

Dads in Mind - Dads in Mind offer both group and 1:1 support to dads supporting their partners with mental health during pregnancy and after birth and/or experiencing depression/anxiety related to their own new role as a parent.

ICON - A website designed to provide support to parents who are struggling with infant crying. Reassurance and coping strategies are offered. There is also advice for professionals.

International Association for Premenstrual Disorders - Support, information, and resources for women and assigned female at birth (AFAB) individuals with Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME).

Make Birth Better - Support for partners affected by birth trauma.

National Association for Premenstrual Syndrome - Provides support with, and assistance in the management of, premenstrual syndromes.

National Childbirth Trust (NCT) - Advice and guidance on postnatal depression in Dads

PND Awareness and Support (PaNDAS) - PaNDAS offers peer support, Facebook groups, chat and email/telephone help for anyone affected by postnatal depression – be it mothers, fathers or families.

Royal College of Psychiatrists – Postpartum Psychosis for Carers - This page aims to explain the symptoms of postpartum psychosis and to describe the care and treatment available.

Tommy’s - Information on recognition and sources of support for PND in fathers.

Further information and reading

British Association for Psychopharmacology – Perinatal (2017) - This consensus document weighs up, in detail, the pros and cons of the use of psychotropics pre-conception, during pregnancy and postnatally.

Medicines and Healthcare Regulatory Agency (MHRA) – Valproate use by women and girls. - Information about the risks of taking valproate medicines during pregnancy – the toolkit includes a credit card-sized patient card to be given out by pharmacists, booklets for healthcare professionals and patients, and a checklist of questions that doctors can use to guide discussions with patients about valproate.

National Collaborating Centre for Mental Health  – The Perinatal Mental Health Care Pathways (2018) - Designed to support the implentation of the NICE antenatal and postnatal mental health guideline, the tables on pages 5-8 offer an easy-to-read summary of the key points in the guidance.

RCGP and GPs Championing Perinatal Care. Antenatal and postnatal mental health NICE guideline CG192. Practical implications for GPs. (2015, updated 2023) - This document was produced by GPs and focuses on the primary care aspects to the content of the NICE guideline on antenatal and  postnatal mental health. It splits it into ten reflective questions which take GPs, and the primary care team, through the most crucial aspects of perinatal mental health in a succinct but informative way.

RCGP 5 minute screencast - Perinatal mental health (2018) - This screencast looks at how we can better identify pregnant and postnatal women within primary care, and the steps that we can take to ensure they get the support and treatment they need.

Royal College of Obstetricians and Gynaecologists – Maternal Mental Health – Women’s Voices (2017) - This report is the result of a survey of over 2300 women in 2016 about their experience of perinatal mental health problems. Key findings included low rates of referral, long waits, regional variations in care, challenges in continuity of care, misunderstanding and stigma. The mental health of women’s partners is also of concern. The report makes some key recommendations on the principles of good care and a brief summary for professionals is on page 15 of the PDF (xiii).

Royal College of Psychiatrists College Report 232 - Perinatal mental health services: Recommendations for the provision of services for childbearing women (2021) - This College Report summarises the latest evidence base for the extent and impact of perinatal mental disorder and opportunities for intervention. It sets out best practice principles and guidance on effective interventions and including the role of general practice (see page 28 of the PDF).

Eating disorders

Guidelines

NICE Guideline [NG69] – Eating disorders: recognition and management (updated 2020) - This guideline covers assessment, treatment and monitoring of children, young people and adults with eating disorders. It covers anorexia nervosa, binge eating disorder and bulimia.

NICE Quality Standard [QS175] – Eating disorders (2018) - This quality standard covers assessment, treatment, monitoring and care for children, young people and adults with an eating disorder.

Royal College of Psychiatrists – MARSIPAN: Management of Really Sick Patients with Anorexia Nervosa: College Report 189 (2014) - MaRSiPAN was created to support clinicians to identify and manage physical health risk when assessing people with eating disorders. Management in primary care is mentioned on page 16 and the sit up-squat-stand (SUSS) test is explained on page 35.

Royal College of Psychiatrists – Junior MARSIPAN: Management of Really Sick Patients under 18 with Anorexia Nervosa: College Report 168 (2012) - The Junior MARSIPAN report provides guidance on risk assessment, physical examination and associated action, including a helpful table on worrying parameters on pages 16-19.

SIGN – Eating Disorders (2021) - Currently (2022) in draft format for consultation, this new guideline is for the range of eating disorders – detection and management.

Useful resources

Hub of Hope - A directory of local services for support with a wide variety of mental health and related issues.

South London and Maudsley – A guide to the medical risk assessment for eating disorders (2009) - Although from 2009, this is a short guide on the assessment of medical risk for patients with eating disorders, and the audience includes primary care.

Young Minds – Anorexia: A guide for young people - This online guide has information for people who think they may be suffering from anorexia nervosa. There is also a link to a guide for parents.

Patient and carer information

Anorexia & Bulimia Care - This charity provides ongoing care, emotional support and practical guidance for anyone affected by eating disorders and eating distress. There are 1:1 support calls, online support groups and other support services for those struggling personally, their family, carers and friends.

Beat Eating Disorders - This website offers information, peer support and links to help for people with eating disorders and their carers.

Royal College of Psychiatrists - Information for patients, carers, family and friends relating to mental health problems and disorders.

Young Minds - This online guide has information for people who think they may be suffering from anorexia nervosa. There is also a link to a guide for parents. A similar guide on bulimia is also available.

Further information and reading

Consider Eating Disorders in Men - An animated training tool for GPs providing key information and help around eating disorders in men, relevant to daily practice.

Guidelines in Practice – Top Tips: Eating Disorders (2019) - 10 top tips for general practice on the role of GPs in managing eating disorders, including signs to look out for, the right questions to ask, and the need for referral.

Guidelines in Practice – Recognise and Support Patients with Eating Disorders (2021) - This article discusses the role of primary care in assessing and monitoring patients who present with symptoms and risk factors for eating disorders.

Healthy London Partnership – Eating Disorders Guidelines for Primary Care  - Created in London, this informative infographic applies elsewhere and has clear information on how to manage and support children and young people with a suspected eating disorder. It includes when to suspect it, physical measurements that are needed and red flags.

RCGP eLearning module – Eating disorders - This course explores the range of eating disorders and how patients affected by them may present to their GP. It offers practical advice to enable clinicians to assess, manage and monitor such patients and know when to refer and when to be concerned.

World Health Organisation – International Classification of Disease (ICD-11) – Feeding or Eating Disorders - Criteria for the diagnosis of eating disorders, and how they are separate from feeding disorders.

Adult autism and ADHD

Guidelines

NICE Clinical Guideline [CG142] - Autism spectrum disorder in adults: diagnosis and management -updated 2021) - This guideline covers diagnosing and managing suspected or confirmed autism spectrum disorder -autism, Asperger’s syndrome and atypical autism) in people aged 18 and over, including updated recommendations on the use of the AQ-10 tool.

NICE Guideline [NG87] – Attention deficit hyperactivity disorder: diagnosis and management -updated 2019) - This guideline covers recognising, diagnosing and managing attention deficit hyperactivity disorder -ADHD) in children, young people and adults. It aims to improve recognition and diagnosis, as well as the quality of care and support for people with ADHD. It also includes recommendations on when pre-medication ECG is needed.

NICE Clinical Knowledge Summary – ADHD -2021) - Attention deficit hyperactivity disorder -ADHD) is a behavioural syndrome characterised by hyperactivity, impulsivity, and inattention. It starts in childhood. Information on features, recognition, diagnosis and management options are covered in this knowledge summary.

NICE Quality Standard [QS39] – Attention deficit hyperactivity disorder -updated 2018) - This quality standard covers diagnosing and managing attention deficit hyperactivity disorder -ADHD) in adults, young people and children -aged 3 and over).

NICE Quality Standard [QS51] – Autism -2014) - This quality standard covers health and social care services for adults, young people and children with autism. It includes assessment and diagnosis of autism spectrum disorders, and care and support for people diagnosed with an autism spectrum disorder.

SIGN Guideline 145 -Assessment, diagnosis and interventions for autism spectrum disorders -2016) - The guideline provides recommendations for best practice in the screening, surveillance, diagnosis, assessment and clinical interventions for children and young people with ASD. It also incorporates evidence and recommendations on assessment, diagnosis and interventions for adults with ASD.

Useful resources

ADHD Foundation - This section of the website has a multitude of resources designed for clinicians and includes guidance on understanding and supporting patients’ ADHD assessment and treatment.

Autistic Spectrum Quotient-10 -AQ-10) - The autism spectrum quotient -AQ-10) tool is recommended for use with adults with possible autism who do not have a moderate or severe learning disability. This may help identify whether an individual should be referred for a comprehensive autism assessment.

Hub of Hope - A directory of local services for support with a wide variety of mental health and related issues.

Patient and carer information

ADHD UK - This website has information on aspects of ADHD including diagnosis -there is a self-screen questionnaire), treatment and obtaining support.

Autism Alliance - This is a network of 17 charities across the UK. It works to support, provide information, research and provide training about childhood and adult autism.

National Autistic Society - This site offers advice on a wide range of issues affecting autistic people and their families.

Resources for Autism - Resources for Autism provides practical services for children and adults with a diagnosis of autism and for those who love and care for them.

Royal College of Psychiatrists - Information for patients, carers, family and friends relating to mental health problems and disorders.

Further information and reading

British Association for Psychopharmacology – Autistic Spectrum Disorders -2018) - Pages 5-6 of the BAP guidelines document are particularly useful as they focus on the assessment and identification of autistic spectrum disorders.

Chamberlain, S., Cortese, S., Grant, J. -2021) Screening for adult ADHD using brief rating tools: What can we conclude from a positive screen? Comprehensive Psychiatry  - This study found that the use of an adult ADHD screening tool considerably over-identified probable ADHD, with low positive predictive value. It offers key advice about the appropriate use of such tools, to maximise benefits and minimise harms.

Substance misuse

Guidelines

Department of Health and Social Care - Also known as the ‘Orange Book’ this is guidance for clinicians treating people with drug problems. It has guidelines on multiple domains, including misuse of prescription and over-the-counter drugs.

NICE Guideline [NG135] Alcohol interventions in secondary and further education - This guideline covers interventions in secondary and further education to prevent and reduce alcohol use among children and young people aged 11 up to and including 18. It also covers people aged 11 to 25 with special educational needs or disabilities in full-time education. It will also be relevant to children aged 11 in year 6 of primary school.

NICE Guideline [CG115] Alcohol-use disorders: diagnosis, assessment and management of harmful drinking -high-risk drinking) and alcohol dependence - This guideline covers identifying, assessing and managing alcohol-use disorders -harmful drinking and alcohol dependence) in adults and young people aged 10–17 years. It aims to reduce harms -such as liver disease, heart problems, depression and anxiety) from alcohol by improving assessment and setting goals for reducing alcohol consumption.

NICE Alcohol-use disorders: diagnosis and management of physical complications - This guideline covers care for adults and young people -aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder.

NICE Guideline [CG120] Co-existing severe mental illness -psychosis) and substance misuse: assessment and management in healthcare settings. - This guideline covers assessing and managing people aged 14 years and over with coexisting severe mental illness -psychosis) and substance misuse.

NICE Guideline [CG52] Drug misuse in over 16s: opioid detoxification - This guideline covers helping adults and young people over 16 who are dependent on opioids to stop using drugs.

NICE Guideline [CG51] Drug misuse in over 16s: psychosocial interventions - This guideline covers using psychosocial interventions to treat adults and young people over 16 who have a problem with or are dependent on opioids, stimulants or cannabis.

NICE Public Health guideline [PH24] Alcohol-use disorders: prevention - This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.

NICE Quaity Standard [QS188] Coexisting severe mental illness and substance misuse - This quality standard covers the assessment, management and care provided for people aged 14 and over who have coexisting severe mental illness and substance misuse.

NICE Quality Standard [QS83] Alcohol: preventing harmful use in the community. - It includes policy and practice approaches to prevent harmful alcohol use in adults, young people and children.

Useful resources

British National Formulary – Anxiolytics and Hypnotics - This section of the BNF includes information on benzodiazepine dependence and withdrawal guidance.

British National Formulary – Substance Dependence - Information and further links regarding nicotine, alcohol and opioid dependence.

Centre for Addiction and Mental Health – DAST-10 - The DAST-10 is a 10 question drug abuse screening tool. This document provides the screening test and some information on its use.

Hub of Hope - A directory of local services for support with a wide variety of mental health and related issues.

NICE Clinical Knowledge Summary – Benzodiazepine and z-drug withdrawal - This CKS topic covers the assessment of a person who is being prescribed long-term benzodiazepines or z-drugs and offers advice on managing withdrawal of treatment.

Public Health England – Guidance on the 5 alcohol use screening tests - Contains guidance on the use of, and links to downloads for the Alcohol Use Disorders Identification Test -AUDIT), Alcohol Use Disorders Identification Test for Primary Care -AUDIT-PC), Alcohol Use Disorders Identification Test C -AUDIT-C), Fast Alcohol Screening Test -FAST) and Single Question Alcohol Use Test -M SASQ).

Public Health England – People who inject drugs -PWID): infection risks, guidance and data - This guide is about infections that occur in people who inject drugs -PWID).

Specialist Pharmacy Service – Choosing an equivalent dose of benzodiazepine - This provides information and guidance on approximately equivalent doses of oral benzodiazepines to diazepam.

Patient and carer information

Adfam - Support and information for the families of drug and alcohol users. It also lists a variety of other organisations who are able to provide support.

Alcoholics Anonymous - AA is concerned solely with the personal recovery and continued sobriety of individual alcoholics who turn to the Fellowship for help.

Dan - This is a drug and alcohol misuse helpline for people in Wales.

Drinkaware - Drinkaware is an independent charity which aims to reduce alcohol-related harm by helping people make better choices about their drinking. They provide evidence-based information, advice and practical resources; raising awareness of alcohol and its harms.

Frank - Frank provides accessible information about drugs and a directory of support services local to people in England.

Narcotics Anonymous - NA helps members to support each other to stay drug free and to help others achieve and maintain a drug free recovery and lifestyle. Meetings are free and do not need to be booked in advance.

NHS - Support and signposting for drug addiction

Inclusion - Inclusion is a national organisation that works with individuals, families and communities who are affected by addiction, crime, mental health or need treatment for their sexual health.

Royal College of Psychiatrists - Information for patients, carers, family and friends relating to mental health problems and disorders.

Further information and reading

Certificant in the Management of Alcohol Problems in Primary Care - This RCGP accredited course aims to improve participants’ understanding of alcohol-related problems and equips participants with the skills and knowledge necessary to manage their patients and supporting carers. A component can be completed as elearning alone.

Certificate in the Management of Drug Misuse -Part 1) - An RCGP accredited course, ideal for those working as part of a shared care scheme intending to provide treatment to drug users as part of a locally or nationally enhanced service. Can also complete a component as elearning alone.

Certificate in the Management of Drug Misuse Update – Be Revalidation Ready - An RCGP accredited course ideal for those working as part of a shared care scheme intending to provide treatment to drug users as part of a locally or nationally enhanced service.

Office for National Statistics: Drug misuse in England and Wales: year ending 2020 - An overview of the extent and trends of illicit drug use for the year ending March 2020. Data are from the Crime Survey for England and Wales.

RCGP eLearning course – Alcohol: Management in primary care - This course covers the physical and mental health problems associated with problem drinking. It also describes the different ways of helping people to cut down their drinking and important aspects of care during and after detoxification.

RCGP Screencast – Screening for alcohol use disorders - This screencast looks at screening for alcohol use disorders, and highlights particular opportunities that shouldn’t be missed. The assessment of drinking and the use of brief interventions are also discussed, as well as an introduction to the motivational interviewing approach to achieving change.

Crisis, self-harm and suicide

Guidelines

NICE Clinical Guideline [CG133] – Self-harm in over-8s: long term management -2011) - This guideline covers the longer-term psychological treatment and management of self-harm in people aged 8 and over. It aims to improve the quality of care and support for people who self harm and covers both single and recurrent episodes of self-harm.

NICE Quality Standard [QS34] – Self-harm -2013) - This quality standard covers the initial management of self-harm and the provision of longer-term support for children and young people -aged 8 to 18) and adults -aged 18 and over) who self-harm.

Useful resources

Hub of Hope - A directory of local services for support with a wide variety of mental health and related issues.

National Suicide Prevention Alliance - A broad range of resources here on suicide prevention and bereavement support

StayingSafe.net - This site is for people in crisis, but it is helpful to spend some time with patients making a safety plan, although they can do this without professional support.

Patient and carer information

Breathing Space - A telephone line for out-of-hours support for over-16s in Scotland.

CALL Helpline Wales - They can be contacted for mental health support and advice via both telephone and text message.

CALM - The Campaign Against Living Miserably movement predominantly focuses on support for men, but this is not exclusive. There are a multitude of help guides on their site, as well as a helpline and webchat.

NHS England - This site will take people to an urgent mental health helpline 24/7, no matter where they are in England.

No Panic - Aside from information, this charity offer a support line and a crisis message for people to listen to when they are having a panic attack.

Papyrus UK - This charity is focused on suicide prevention in children and young people. There are crisis contacts, information for parents/carers and also for professionals on how to support young people who are struggling with their mental health, especially if they are experiencing suicidal ideation.

Prevent Suicide - A Scottish-based suicide prevention app and website offering a range of support options for people who may be in distress. The app gives users who may be at risk of suicide the option to write their own safety plan with helpful prompts to guide the user through the process.

Royal College of Psychiatrists - Information for patients, carers, family and friends relating to mental health problems and disorders.

Samaritans - Available 24/7 by calling 116 123 -free) or emailing jo@samaritans.org.uk -24h response time)

Shout  - Crisis text line - text Shout to 85258

StayingSafe.net - A site for people in suicidal crisis, with support to make a safety plan and links to other resources.

Support after Suicide Partnership - The Support After Suicide Partnership brings together suicide bereavement organisations and people with lived experience, to offer timely and appropriate support for everyone bereaved or affected by suicide. The timeline of what happens after a suicide, and how people may be feeling, is particularly helpful.

Silence of Suicide - This is for anyone who wants to support with their mental health in general, or in crisis.

Survivors of Bereavement by Suicide - This is a peer-led organisation offering peer-to-peer support to all those over the age of 18, impacted by suicide loss in the UK.

Further information and reading

Connecting with People - 4 Mental Health are an organisation delivering Connecting with People training – modular training sessions on a wide range of mental health subjects, including suicide and self-harm mitigation.

Distress Brief Intervention - This Scottish initiative, called DBI, consists of two parts, with part 1 seeing trained front-line health, police, paramedic and primary care staff help ease any individual.  They then ask the person if they would like further support and, if they agree, they are referred to the DBI service with a promise of contact within the next 24 hours to start providing further face-to-face support.

Mughal, F., Troya, MI., Dikomitis, L. et al. Role of the GP in the management of patients with self-harm behaviour: a systematic review. BJGP 2020; 70 -694): e364-e373 - GPs recognise self-harm as a serious risk factor for suicide, but some feel unprepared for managing self-harm. The role of the GP is multidimensional and includes frontline assessment and treatment, referral to specialist care, and the provision of ongoing support.

Oxford University Centre for Suicide Research – Clinical guide: Assessment of suicide risk in people with depression - The guide was developed to assist clinical staff in talking about suicide and assessing suicide risk with people who are depressed.

RCGP eLearning module – Mental health and suicide prevention - This module is one of a suite of courses looking at the health, wellbeing and service provision issues for patients who identify as lesbian, gay, bisexual or transgender -LGBT).

RCGP eLearning course – Suicide prevention - This course gives a clearer idea of when suicidal risk needs to be considered, sources of support, resources for yourself and your patient, and an appreciation of the next steps in suicide prevention training.

University of Manchester - National Confidential Inquiry into Suicide and Safety in Mental Health - This study has collected in-depth information on all suicides in the UK since 1996. Their recommendations have improved patient safety in mental health settings and reduced patient suicide rates, contributing to an overall reduction in suicide in the UK.

University of Manchester – Safer care for patients with personality disorder -2018) - This report examines the characteristics of patients with a diagnosis of personality disorder prior to suicide or homicide.

Physical health and mental health

Guidelines

British Association for Psychopharmacology guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment -2016) - This guideline, although mainly aimed at secondary care, describes the risks associated with antipsychotic usage and interventions that may address them. Pages 4-6 of the document are particularly pertinent to primary care.

Useful resources

Lester Screening Tool - This is an physical health screening tool and intervention framework for people with a diagnosis of psychosis or schizophrenia.

Patient and carer information

RCPsych: Coping with physical illness - This discusses how serious physical illness, and the treatment for it, can affect mental health.

RCPsych: Medically unexplained symptoms - Information from the RCPsych on MUS for patients, including an explanation of the problem, self-help and treatments.

Further information and reading

Academy of Medical Royal Colleges - Improving the physical health of adults with severe mental illness: essential actions -2016) - This report recommends practical ways to improve physical healthcare services for people with SMI.

Early Intervention in Psychosis (PDF file, 1,346 KB) – Keeping the Body in Mind -2014)  - This short guide illustrates the Lester approach to protecting cardiometabolic health in psychosis.

Medically Unexplained Symptoms -2014) - Advice and guidance for health professionals in approaching medically unexplained symptoms.

NHS England and NHS Improvement - an Approach to Reducing Health Inequalities: supporting information Core20PLUS5 -2021) - Core20PLUS5 is a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both the National and System level. It includes work on five clinical areas of focus, including severe mental illness -SMI): ensuring annual health checks for 60% of those living with SMI -bringing SMI in line with the success seen in learning disabilities).

NHS England – Improving the physical health of people with serious mental illness – A practical toolkit -2016) - This toolkit takes a practical approach to the elements of improving physical health for people with SMI, including what needs to be done, and by whom.

NHS England – Improving physical healthcare for people living with severe mental illness -SMI) in primary care -2018) - Although aimed at commissioners, this guidance is focused on securing improvements in physical health care for people with SMI within primary care, where the majority of people living with an SMI receive their care and treatment.

NHS England - Promoting Awareness of physical health in people with a serious mental illness -2018) - This 7 minute video uses a case study to demonstrate how we can facilitate the physical health care of people with serious mental illness.

Pharmacy Guidance on Smoking and Mental Disorder (PDF file, 522 KB) - This quick reference guide looks at the benefits of smoking cessation in mental health patients, including effective smoking cessation and reduction interventions and prescribing considerations.

RCGP Screencast – Supporting mental health in low-income communities: learning from the DeSTRESS project - This eLearning screencast discusses the DeSTRESS project, which was set up to understand the challenges facing GPs who see patients with mental distress relating to poverty. The screencast explains some of the evidence linking poverty to poor mental health and discusses some of the difficulties that GPs may face when dealing with such patients.

RCGP Top Tips - Psychodermatology - Psychodermatological disease is incredibly common, yet it often goes unrecognised and untreated.

Treating Depression in People with Coronary Heart Disease - Primary care guidance on spotting and treating depression in people with coronary heart disease.

Wonca guidance on caring for the physical health of patients with severe mental illness -SMI) - This guide links to a variety of factsheets and PowerPoint slides on physical health in SMI, including diabetes, smoking, respiratory disease, alcohol and substance misuse and cardiovascular disease.

Practitioner health

Guidelines

General Medical Council – Good Medical Practice - Points 28-30 of domain 2 refer to practitioner health. The key message is that if a doctor knows or suspect that your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague and follow their advice.

Useful resources

Business in the Community – Mental Health for Employers Toolkit -2021) - Business in the Community -BITC) has partnered with Public Health England to produce a toolkit to help every organisation support the mental health and wellbeing of its employees.

Health and Social Care Public Health Agency – Breathing Space - This quick reference sheet is designed by the Public Health Agency in Northern Ireland and helps staff take a short break to protect their mental wellbeing.

Lifelines Scotland - Supporting the mental health of people who work or volunteer with an emergency service in Scotland.

NHS Practitioner Health - England and Scotland: Practitioner Health is a free, confidential NHS primary care mental health and addiction service with expertise in treating healthcare professionals.  The service can help with mental health conditions such as depression, anxiety and obsessive-compulsive disorder. They also see healthcare professionals with more severe illnesses, such as bipolar affective disorder, personality disorders and psychosis and with a range of addiction issues. The special needs of healthcare professionals with mental illness are recognised in their approach.

Northern Ireland Medical and Dental Agency - Offer a small professional support unit to all medical and dental trainees in Northern Ireland. Contact: 02890 400000

Sick Doctors Trust - Support and help for doctors, dentists and medical students who are concerned about their use of drugs or alcohol.

Patient and carer information

BMA Counselling - The BMA counselling service provides constructive advice and support to medical students and doctors, regardless of BMA membership.

BMA Doctor Support Service - The BMA runs this service on behalf of the GMC, to offer emotional help to doctors under investigation

BMA Peer Support - This service gives you an opportunity to speak in confidence to another doctor.

Doctors’ Support Network - Peer support for doctors and medical students with mental health concerns.

DocHealth - Run by the BMA and the Royal Medical Benevolent Fund -RMBF), DocHealth is a confidential psychotherapeutic consultation service for all doctors. The RMBF also hosts an advice hub with support for a multitude of challenges that may face doctors.

General Medical Council – Managing your health - For doctors with health issues, or those who have been referred to the GMC because of a health concern, this guide will help find available support.

General Medical Council – Support for Doctors Under Investigation - This site hosts support information from the GMC and also links to a wide variety of resources to help doctors in difficulty.

Health for Health Professionals – Wales - A confidential service providing face to face counselling service for all doctors in Wales.

Hope 4 Medics - A support website for doctors with disabilities, to help them overcome barriers they may face in the workplace, and facilitate a long-term, successful career.  Signposts to additional resources that may help doctors with disabilities.

NHS Staff Support - This site is for English NHS staff and has links to support, ‘how to’ guides and health and wellbeing programmes.

Rightsteps - Supported by the Royal Medical Benevolent Fund, and for medical students, Rightsteps wellbeing is a on-demand wellbeing platform where you can choose mental and physical wellbeing support from their range of self-guided wellbeing recources.

You Okay, Doc? - This is a service for doctors and medical students and includes ‘The Huddle’ - a safe space for doctors to chat in a private group about things that are not often freely talked-about elsewhere. There is also a crisis text service – text YOD to 85258.

Further information and reading

ACAS – Management of Mental Health at Work -2016)  - Research report on the management of mental health at a cross section of workplaces to provide valuable insights and identify good practice.

ACAS – Supporting Mental Health at Work - This page has information on, and further links to, guidance on mental health promotion and management at work. It touches on legal issues, discrimination and creating a supportive environment.

Connecting with People - 4 Mental Health are an organisation delivering Connecting with People training – modular training sessions on a wide range of mental health subjects, including emotional resilience and compassion in the workplace

General Medical Council – The State of Medical Education and Practice in the UK - ‘The state of medical education and practice in the UK’ is the GMC’s annual report on the realities and challenges faced by medical professionals in the UK’s healthcare systems, and includes information on mental wellbeing and burnout.

Mental Health First Aid - This is a social enterprise who are nationally delivering support to workplaces through training and resources. They support organisations to look after the mental health of employees, such as through the training of Mental Health First Aiders.

RCGP eLearning blog – Managing stress and avoiding burnout in primary care. - This blog explores the fact that being a GP can be an extremely varied and rewarding career, but the pressure of dealing with an ever-increasing number of patients can take its toll.

RCGP eLearning  module - COVID-19 and staff mental health - This two module course covers two areas which are particularly pertinent to the mental health and wellbeing of clinical staff in the context of the COVID-19 pandemic.

RCGP eLearning module – Drugs: Management of drug misuse - This course builds on the Identification and Harm Reduction course, and describes an evidence-based approach to the treatment of substance misuse in primary care, including the role of opiate substitution therapies -OST).

RCGP eLearning course – Mental health in the context of COVID-19 - This collection of resources is specifically designed to support the mental health and wellbeing of the GP workforce and the healthcare community at large. The resources aim to help with the mental and physical state of the workforce, address current and future challenges, allow healthcare professionals to feel supported.

RCGP eLearning course – Practice staff health - The aim of this module is to offer general practitioners and practice managers practical approaches to protecting staff wellbeing, and to inspire the development of healthy workplaces.

RCGP Screencast – Mental ill health and burnout - In this screencast the the epidemiology of doctors’ mental health difficulties and burnout are discussed. Suggestions are made on how to engage with struggling colleagues and where to seek help.

RCGP Screencast – Post traumatic stress disorder during and after lockdown - This extended screencast focusing on the period of lockdown during the COVID-19 pandemic and the potential effects on patients and key workers during and after this period. It looks at recognising signs of post traumatic stress disorder, screening in primary care and how GPs can look after themselves during this challenging time.

RCGP Screencast – Traumatic events in primary care - Primary care team are often being exposed to stressful, negative experiences. This screencast covers the difficult topic of how to deal with traumatic and morally injurious events in general practice, the signs of PTSD and when to seek help.

RCGP Webinar – Protecting doctor wellbeing: PPE for the mind - This webinar covers how to recognise the early warning signs of burnout and mental ill health in the workplace, what helps when working in traumatic situations – the evidence, and helps you to create your own psychological PPE toolkit to help protect you now and in the longer term.

Mental health legislation

Guidelines

England and Wales

Mental Capacity Act -2005) - This is the link to the most recent version of the Mental Capacity Act -2005)

Mental Capacity -Amendment) Act - 2019) - The Amendment Act amends the Mental Capacity Act 2005 in relation to deprivation of liberty where the person lacks capacity to consent.

Mental Health Act - 1983) Code of Practice - The code of practice advises professionals on how to carry out their responsibilities under the Mental Health Act 1983, and provide high quality and safe care.

Mental Health Act - 1983) - This is the link to the Mental Health Act -1983)

Mental Health Act - 2007) - This link is to the paper amending the Mental Health Act -2007) and includes a summary of updates to the 1983 version.

NICE Quality Standard [QS194] – Decision making and mental capacity - This quality standard covers decision making in people aged 16 and over, using health and social care services who may lack capacity to make their own decisions -now or in the future). It aims to support implementation of the aims and principles of the Mental Capacity Act 2005 and relevant Codes of Practice.

Scotland

Adults with Incapacity - Scotland) Act 2000 - The Adults with Incapacity -Scotland) Act 2000 creates provisions for protecting the welfare of adults who are unable to make decisions for themselves because of a mental disorder or an inability to communicate.

The Mental Health - Care and Treatment) -Scotland) Act 2003 - As amended in 2017 by the Mental Health -Scotland) Act 2015

Useful resources

BMA Mental Capacity Act toolkit - 2020) - This toolkit acts as a prompt to doctors when they are providing care and treatment for people who lack, or who may lack, the mental capacity to make decisions on their own behalf.

RCGP Mental Capacity Act-MCA) Toolkit for Adults in England and Wales - This tool kit is designed provide information and support for the application of the Mental Capacity Act to GPs and Primary Care Staff.

Patient and carer information

CQC – Your rights under the Mental Health Act-This website is designed for people detained under the Mental Health Act to explain their rights.

Further information and reading

CQC – Mental Health Act Code of Practice - This 2015 document by the Care Quality Commission is an interesting evaluation of how the code is being used and areas for improvement.

Deprivation of Liberty Safeguards - DoLS) - eLFH - This series of modules looks at the background to DoLS, making an assessment and the process of obtaining a DoLS authorisation.

Reforming the Mental Health Act – Summary of Consultation - This document summarises the main changes to the Mental Health Act which are proposed. The consultation on changes to the Mental Health Act has resulted in 154 recommendations for improvement.

Second Opinion Appointed Doctors - SOAD) - The CQC is responsible for the appointment of SOADs. The role of the SOAD is to decide whether the treatment recommended is clinically defensible and whether due consideration has been given to the views and rights of the patient.

Section 12 Approval - Approval under Section 12 of the Mental Health Act confers the ability to deprive individuals of their liberty and curtail their human rights. Section 12-2) of the Mental Health Act 1983 requires that, in those cases where two medical recommendations for the compulsory admission of a mentally disordered person to hospital are required, one of the two must be made by a practitioner approved for the purposes of that section.

Medical and psychological treatments

Guidelines

British Association for Psychopharmacology - Evidence-based guidelines for treating depressive disorders with antidepressants -2015) - These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Pages 3-9 of the document are particularly pertinent to primary care.

British Association for Psychopharmacology -Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder -2014) - Each of the principal disorders – generalised anxiety disorder, panic disorder, specific phobia, social anxiety disorder, post-traumatic stress disorder, and obsessive-compulsive disorder – is considered in turn, following key steps in management -acute treatment; longer-term treatment; combination with psychological approaches; treatment resistance). Pages 4, 6-7 and 9-10 of the document are most relevant to primary care.

NICE Clinical Knowledge Summary: Antipsychotics -2021) - All the information required for the prescribing and monitoring of antipsychotics in primary care.

NICE Clinical Knowledge Summary: Lithium -2021) - All the information required to prescribe and monitor lithium, including spotting symptoms and signs of toxicity and the actions to take.

Useful resources

ACB Calculator - Many of the medications that we commonly prescribe have anticholinergic properties. In patients over 65 years of age these can cause adverse events, such as confusion, dizziness and falls. These have been shown to increase patient mortality. This calculator works out the anticholinergic burden for the patient. A score of 3+ is associated with an increased cognitive impairment and mortality.

British National Formulary - Treatment summaries on antidepressants, antipsychotics, hypnotics and anxiolytics and dementia are very helpful.

CredibleMeds - This website is a useful resource when considering medications and the risk of QT_c prolongation. One-time registration is required, but it is free.

emc - The electronic medicines compendium is a repository of the summary of product characteristics -SPC) and patient information leaflets -PIL) for drugs prescribed in the UK. The SPCs include detailed information on usage, contraindications and side effects.

Living Life - The Living Life service offers support to people in Scotland through guided self-help and cognitive behavioural therapy. It is self-referral.

MDCalc - This benzodiazepine conversion calculator provides equivalent doses between different benzodiazepines.

National Centre for Mental Health - They offer a ‘Medication Handy Chart’ which can be used as a quick reference guide for clinicians when discussing mental health medication with patients. The chart contains information on hundreds of common mental health medications, including their use, effects and side effects. Information is impartial and has been written and checked by expert pharmacists. It can be ordered by emailing info@ncmh.info.

Specialist Pharmacy Service – Choosing an equivalent dose of benzodiazepine - This provides information and guidance on approximately equivalent doses of oral benzodiazepines to diazepam.

UK Drugs in Lactation Advisory Service -UKDILAS) - UKDILAS provides evidence based information on the use of drugs during the breastfeeding period.

UK Teratology Information Service -UKTIS)  - This site and offers information on the use of medication in pregnancy and is linked to ToxBase -which has more detailed reviews)

Patient/Carer Information

Best Use of Medicines in Pregnancy -BUMPS) - This website provides reliable, evidence-based, and accurate information about use of medicines in pregnancy, in the form of freely available patient information leaflets, written by the UK Teratology Information Service.

Changing Minds - Relaxation tools and wellbeing resources in different languages which may be suggested to patients

Foundation for Positive Mental Health - A charity dedicated to promoting skills training for positive mental health, to enhance everyday wellbeing, increase resilience to, and recovery from, mental health difficulties. It offers skills training for positive mental health, derived from Olympic sports.

Mind: Psychiatric Medications - Explains what psychiatric drugs are, what to know before taking them, and information on side effects and coming off medication.

RCPsych: Antidepressants - This section of the website provides information on the use of antidepressants, including commonly asked questions. There is a further section on stopping antidepressants.

RCPsych: Cognitive Behavioural Therapy - Information for patients on what CBT is and how it can help.

RCPsych: Psychotherapies and psychological treatments - Details on the type of therapies, highlighting the fact that the Improving Access to Psychological Therapies -IAPT) service is available through primary care in England.

Further Information and Reading

Association for Cognitive Analytical Therapy -ACAT) - This includes info about CAT as a therapy & also as a consultation model.

British Association for Psychopharmacology – Benzodiazepines: Risks and benefits. A reconsideration. -2013) - This short, interesting document looks at the pros and cons of benzodiazepine prescribing, including information on stopping them.

RCGP eLearning module – Mental health in times of lockdown - This extended screencast looks at various factors during lockdown that may contribute to mental health problems for patients, including grief, domestic abuse and increased alcohol intake.

RCGP – Mindfulnes for GPs and Primary Care Teams - This explains what mindfulness is, how it helps and signposts to resources.

Responsibility without Blame - The Responsibility without Blame Project provides a free and accessible e-learning for anyone interested in thinking about our ideas of responsibility and blame, and finding ways to work and relate more effectively with people with personality disorder or complex needs.

Strategic and commissioning resources

Health and Social Care Board Northern Ireland - The Health and Social Care Board (HSCB) plans and develops services for people with mental health needs, in partnership with the Public Health Agency.

Mental Health Strategy 2017-2027 (2017) - The Scottish Government's approach to mental health from 2017 to 2027 – a 10 year vision. This is supplemented by the Mental Health programme for Government delivery plan (2018) which sets out the approach to the mental health commitments made in the Strategy.

National Suicide Prevention Alliance - This website hosts suicide data sets and information on policy and strategy to use as a resource for service development and planning.

NHS England – Mental Health Commissioning - This website carries the approach to, and structue for, mental health commissioning in England.

NHS England and NHS Improvement (2018) - This guidance sets out the policy initiatives and strategic context for transforming perinatal mental health care. It explains why this transformation must be a priority for commissioners, providers and sustainability and transformation partnerships (STPs) and integrated care systems (ICSs).

NHS Long Term Plan (2019) - Set out in 2019, the Long Term Plan looks at the priorities for development of care – including mental health – over five years.

NHS Mental Health Implementation Plan 2019/20 – 2023/24 (2019) - This implementation plan builds on the 5 Year Forward View for Mental Health (2016) and looks to ensure that the NHS provides high quality, evidence-based mental health services to an additional 2 million people. It sets ambitious goals to improve mental health services.

NHS Wales – Mental Health Commissioning - This site explains the structue of, and responsibilities for, mental health commissioning in Wales.

Public Health England – Alcohol, drugs and tobacco: commissioning support pack - The aim of this commissioning support guidance is to help commissioners and local authorities develop joint strategic needs assessment and health and wellbeing strategies to reduce the harm caused by drugs and alcohol.

Scottish Government – Mental Health Strategy 2017 – 2027 - A collection of resources for Scotland’s mental health strategy.

Scottish Government – Mental Health Strategy 2017 – 2027: First Report - This is the first progress report on the Mental Health Strategy 2017 to 2027.

The King’s Fund (2020) Mental health and primary care networks. Understanding the opportunities - This report explores the opportunities the development of primary care networks (PCNs) creates for improving the support and treatment provided to people with mental health needs in primary care.

Together for mental health: our mental health strategy (2012) - The Welsh strategy for mental health; the basis for further documents such as the Mental health delivery plan 2019 to 2022 and Together for Mental Health Delivery Plan 2019 - 2022: impact assessment.

The King’s Fund (2022) - This site offers and overview of, and links to, key policies, reports and resources in mental health. There are a variety of documents, podcasts and blogs to make the information accessible.

Welsh Government - This is a summary of guidance to provide effective services for substance misuse treatment in Wales. 

Wales Mental Health in Primary Care (WaMH) - This organisation brings together people with an interest in improving and developing mental health in primary care in Wales. The collaboration is between mental health practitioners, professionals, agencies, organisations, carers, service users and their friends and family.