GPs should take a bigger role in care of long term mentally ill patien
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《英国医生杂志》
The mental health charity Rethink is urging GPs to take a bigger role in the care of people with long term mental illness. Its latest report says that people with severe, long term psychiatric conditions are 15 times more likely than the general population to contract HIV, twice as likely to die from respiratory diseases, and approximately three times as likely to be smokers. However, these people are often overlooked by primary and secondary services alike.
"We are talking about people who have suffered from a severe mental illness for more than 10 to 15 years and have been in contact with services for a long period of time," said Paul Farmer, Rethink抯 director of public affairs, at the launch of the report this week. "We have called these people the forgotten generation. The mental health service is geared towards people experiencing crises or suffering from unstable conditions. The forgotten generation, by contrast, place few demands on health or social services. They are relatively isolated, and their contact is mainly restricted to collecting their medication."
Rethink estimates that 74% of people with schizophrenia in institutions smoke and that many patients also experience problems with obesity. They may also develop side effects as a result of long term use of drugs, yet few are offered regular check ups to assess their state of health. Although Rethink applauds the provision in the new GP contract of ?600 to practices to offer annual health checks to all patients, it hopes that the new revised contract will require GPs to be more active in contacting people at risk because of their mental illness.
"The forgotten generation are less forthcoming than they might be about seeking treatment," said Paul Farmer. "Currently the system relies on service users giving consent to be on a register of the mentally ill yet requires no work to dispel the negative connotations of this term."
The public health white paper of November 2004 highlighted concerns about the physical health needs of people with long term psychiatric conditions. Rethink is keen to see GPs encouraged to refer patients to smoking cessation clinics and to provide them with prescriptions for exercise, which not only improves patients?general health but can expand their social networks, according to research conducted by the charity.
It would also like to see GPs acting as a "gateway" to more varied forms of help. "General practice may be the main form of contact with the health service for these people," said Mr Farmer. "They are in a position to open the door to constructive treatment."
The report recommends regular health checks and HIV and hepatitis C tests for patients; greater access to services that promote health; flexible referral criteria so that any professional can refer a patient to healthcare, social, or educational programmes; and better training for nurses and GPs. Recent surveys showed that only 2% of practise nurses had received formal training in mental health.
The Royal College of Psychiatrists and the Royal College of Nursing both welcomed the report. "In recent years the mental health service has prioritised areas where outcomes can be quickly identified," said Mr Farmer. "It has been rationed to a relatively small number of people; those considered 憇table?are not getting a fair deal."(Madeleine Brettingham)
"We are talking about people who have suffered from a severe mental illness for more than 10 to 15 years and have been in contact with services for a long period of time," said Paul Farmer, Rethink抯 director of public affairs, at the launch of the report this week. "We have called these people the forgotten generation. The mental health service is geared towards people experiencing crises or suffering from unstable conditions. The forgotten generation, by contrast, place few demands on health or social services. They are relatively isolated, and their contact is mainly restricted to collecting their medication."
Rethink estimates that 74% of people with schizophrenia in institutions smoke and that many patients also experience problems with obesity. They may also develop side effects as a result of long term use of drugs, yet few are offered regular check ups to assess their state of health. Although Rethink applauds the provision in the new GP contract of ?600 to practices to offer annual health checks to all patients, it hopes that the new revised contract will require GPs to be more active in contacting people at risk because of their mental illness.
"The forgotten generation are less forthcoming than they might be about seeking treatment," said Paul Farmer. "Currently the system relies on service users giving consent to be on a register of the mentally ill yet requires no work to dispel the negative connotations of this term."
The public health white paper of November 2004 highlighted concerns about the physical health needs of people with long term psychiatric conditions. Rethink is keen to see GPs encouraged to refer patients to smoking cessation clinics and to provide them with prescriptions for exercise, which not only improves patients?general health but can expand their social networks, according to research conducted by the charity.
It would also like to see GPs acting as a "gateway" to more varied forms of help. "General practice may be the main form of contact with the health service for these people," said Mr Farmer. "They are in a position to open the door to constructive treatment."
The report recommends regular health checks and HIV and hepatitis C tests for patients; greater access to services that promote health; flexible referral criteria so that any professional can refer a patient to healthcare, social, or educational programmes; and better training for nurses and GPs. Recent surveys showed that only 2% of practise nurses had received formal training in mental health.
The Royal College of Psychiatrists and the Royal College of Nursing both welcomed the report. "In recent years the mental health service has prioritised areas where outcomes can be quickly identified," said Mr Farmer. "It has been rationed to a relatively small number of people; those considered 憇table?are not getting a fair deal."(Madeleine Brettingham)