Dr. Ray Walley:

General practitioners, GPs, are often the first point of contact for those suffering from mental illness. International best practice suggests that the majority of emotional and psychological problems, such as anxiety disorders and mild to moderate depression, can be adequately managed by GPs in the community without referral to specialist mental health services.

The value of psychological therapies, including counselling, cognitive behavioural therapy, psychotherapy and group therapy, is widely recognised in the treatment of patients with mental health issues. There is increasing evidence that exercise is effective in the treatment of mild depression and anxiety. It is recommended in A Vision for Change that all individuals should have access to a comprehensive range of interventions in primary care for disorders that do not require specialist mental health services. Failure to provide adequate counselling, psychotherapeutic and occupational therapy services and support in primary care can therefore lead to an over-reliance on drug therapy or unnecessary referral to equally under-resourced specialist mental health services. Current counselling in primary care services are provided to adult medical card holders only. Meanwhile children and those entitled to a doctor visit card are left reliant on the private system where the cost is often prohibitive and where the regulation of counsellors and therapists is only now being introduced.

Our GPs describe the situation in our CAMHS as "heart sink". Young patients with serious mental health and behavioural problems face long delays for assessment, with urgent access only available through emergency out-of-hours services or emergency departments. With insufficient resources allocated to general practice and limited access to supports and psychotherapy services in community or primary care, referrals to CAMHS are increasing. At the same time, pressures on CAMHS have raised the threshold for acceptance and patients are increasingly referred back to the GP without assessment and where options for treatment in the community are limited.

The IMO is calling for sufficient resources to be allocated to general practice with direct access, on GP referral, to publicly funded counselling, psychotherapeutic and occupational therapy services and supports in the community.