Primary care services are the first place people access when they want to begin a journey into mental health treatment and recovery. That first connection is one of the most important connections. It can make or break the beginning of your search for help. We’re asked to open the conversation, but, at the heart of it, opening up is half the battle. Whether the person you open up to actually actively listens and offers their supportive words and expertise – now that is the complementary puzzle piece.
It can be really exhausting to seek help, particularly if you receive knock-backs. In my volunteer work, offering lived experience advice in an eating disorder support group, I advise people to keep at their primary care service, but I often hear similar experiences from each person. They feel rejected, put out, and invalidated when they reach out. This caused them to withdraw and not go on to seek any further help.
A reaction I had when I first sought help for my anxiety.
I am now medicated for my anxiety, but this was after several years of struggling with my mental health, and an attempt at seeking such help which was detrimental to any further attempts. It took me, unfortunately, around five and six years to fully push through, after hitting several busy GP surgery telephone lines, and a few years of wellbeing counselling. The second time of entering a GP’s office was a much more validating experience, and something I think GPs should take some note from.
The support I received from two GPs were polarising, and each defined moments in my mental health journey.
What you might find, or what you might have done yourself, is that those who aim to receive help for their mental health go into the GP with an initial physical problem and can piggyback their mental health off it. I did this. Retrospectively, I shouldn’t have, but I didn’t quite know how to approach speaking about my mental health.
And, the response I received was not the one I fully expected.
So, I went to a GP when I was around 19 or 20; bearing in mind I’d been experiencing anxiety, brushed off as hormones, for several years at that point. I was a student at the time, so was registered as a patient at my university’s GP. This was, of course, a highly busy GP, as it wasn’t just the student population, but people who lived in the area surrounding the university. There were only handful of GPs to treat a high volume of patients, and, like most GP surgeries under our NHS, they were overstretched and underfunded.
But, again, the response I received was not the one I fully expected.
I entered the GP’s office, toying with the idea of speaking about my anxiety, as I had thought about doing the other times I visited the surgery for other ailments and reviews for my asthma. She asked the standard “how can I help you today?” I launched into a description of my ailment. I am unsure if was a recurrent earache, or the beginning of my recurring gastritis, but that’s beside the point. It was a short description, as I knew the GP had a time limit, and a lot of patients to see. Then, before I could think of my next word, I heard the piggyback come out of my mouth. Quick as anything, very unsure of what to actually say but trying to get the gist of it all, I followed up my first ailment with a request to talk about my anxiety.
Before I could even finish the sentence, she sharply cut me off by raising her hand, and said: “we’re not going to talk about that.”
That very sentence deeply and negatively impacted me for years after.
The second she shut down that avenue of conversation, I clambered up and the thought of even discussing my anxiety again was inconceivable. I didn’t attempt to seek primary care help again, until February of this year. Nearly six years after that encounter. I felt so completely humiliated.
Who did I think I was going in to speak about my anxiety? How stupid could I be?
That statement cemented my thought process of: I don’t matter. I am over-exaggerating. I am so stupid to even think someone would care.
To have that door slammed in your face, and the windows bolted shut, reinforces the idea that no one can help you, that you are not deserving of that help. That feeling is something that holds so many people back from reaching out. You are exposing yourself, making yourself so vulnerable, and to be cut off before you even get a chance… I remember walking away from that appointment, defeated. It had taken me so much courage to finally walk into the GP office and ask for help, and I wasn’t even allowed to finish my sentence. There wasn’t even a suggestion from the GP to table the mental health request for another appointment, or to ask me what I would prefer to talk about it. It was a point blank refusal to speak about something that had been troubling me for years.
Adding insult to injury, to have that conversation stopped before it even started completely invalidated me. I had experienced that feeling for so long with my anxiety being brushed off as teenage hormones. The GP telling me she did not want to listen brought up that negative self-schema I held that she believed me to do a ridiculous and stupid typical student who was getting stressed over nothing. Because, let’s face it, students get that classic rep of ‘all you do is drink and do one essay while getting free money from the government. What do you have to be stressed about?‘
First of all, university is an incredibly stressful time and that stress and anxiety exists outside the lecture hall and library. Second of all, some of us have anxiety that has existed a long time and completely outside university altogether.
However, to know that a GP whose main patient demographic are university students may have this aforementioned attitude towards students does not spur hope. I immediately felt like I was overexaggerating my anxiety. As though I was lying to myself, and actually being an oversensitive cry-baby. People deal with much bigger issues and don’t get anxious. Anxiety only exists in enormous panic attacks and with a real reason to be stressed. Completely negating the fact that panic attacks come in different forms, and there was lots of reasons I behaved anxiously or was sensitive to certain situations which illicited such an anxious response. But, if a GP decided that we weren’t talking about it, then okay my anxiety wasn’t that bad and I had to get over it.
So, my anxiety niggled away at my wellbeing while I tried to regain the courage to seek out help, sabotaging so many aspects of my life.
Now, that’s not to say the GP was the reason my anxiety worsened, but she was one of my attempts at seeking help. That could have been a key moment of early intervention, but instead I left the surgery with my tail between my legs, and didn’t contact a GP again for years to come.
When I moved back home, following my postgraduate in Swansea, I returned to the GP surgery I had been registered with up until I went to Stirling. I have been fully registered with this GP now for two years, and this year, after several attempts at trying to phone through to another very busy GP surgery, I sought help for my anxiety again. This followed a minor relapse in disordered eating and a decision that I couldn’t continue to manage my anxiety in such a maladaptive and isolated way. As I mentioned, I had to call several times over the course of several days. I had to deal with several engaged dial tones. I had to deal with catching the surgery when the doctors were unavailable for telephone consultations. Until, eventually on my day off, I phoned and phoned and phoned and phoned, and I was transferred through to a doctor. It had been so long since I tried to seek help from a GP. Yet the concern that I was about to experience another refusal to listen to me still clung close.
So, when I began to tell him what was wrong, I had to stop to compose myself, my voice breaking, full of years of exhaustion and upset, and he didn’t interrupt me until I got to the end of my request for support. Instantly, he asked that I come into the surgery that day for a face-to-face visit. Within an hour, I found myself in a similar situation to that of five or six years before. But, this time, I was going in to speak solely about my anxiety, and I received a very different outcome.
By not being interrupted during my telephone consultation, I already felt more secure. I hadn’t been shooed off. I hadn’t been shut down. I hadn’t been made to feel that my mental health did not matter as much as my physical health.
As the GP asked me to sit and explain what I came in for, I was at a loss for words. Although more confident, and with a sudden new lease of life and motivation, I still harboured that worry that I was going to be shut down again. However, he was patient and encouraged me to say whatever was on my mind. I managed to tell him that I had been struggling with anxiety for a long time and really needed help. I was physically shaking. My voice was breaking, wobbling…
And, he listened. And, he understood.
I was so frightened that I was going to be let down again. That I was never going to get help for my anxiety. He let me talk, and get all the information I needed to get out, to help him provide the best care he could. He reassured me of my concerns, and said something I have never forgotten. I’ve mentioned this everywhere I go when I discuss my anxiety and getting help from a GP. He asked me when did I first notice my anxiety appearing, and I shrugged my shoulders, simply saying I couldn’t pinpoint an exact moment, but I had been as anxious as long as I could remember. So, he summarised this: you’ve been anxious for so long that you don’t remember what it’s like to not be anxious.
That sentence alone made up for my first experience, concerning my mental health. I already felt much more secure.
The understanding of mental health can really separate GPs. It can help or hinder a person’s first steps in their journey to mental health recovery or improvements. My second GP allowed me to open up. He gave me time to speak, asked if there was anything I would prefer to talk about. He explained the medication to me, and offered some valuable therapeutic help with a number to access talking therapies and peer support if needed. He asked what I would prefer in terms of treatment, as some people don’t like to be on medication.
He valued me, and took my thoughts and feelings into consideration.
In retrospect, I absolutely shouldn’t have went in with another ailment to discuss first, as GPs do have time constraint. So, bear that in mind if you are seeking advice and assistance from primary care services. Try your hardest to go in with your mental health being the forefront of the discussion. Maybe my first interaction would have been different if I did that. But, I certainly don’t think a GP should tell someone that she is refusing to talk about the patient’s anxiety.
This is why it is so essential that GPs are taught how to work with both physical and mental health. Particularly now with mental health becoming an increasingly significant crisis with COVID-19subject. I think if I didn’t have such a successful GP appointment the second time around I may have really struggled to have the courage to seek help again, especially after how long it took me to regain that courage from the first time. GPs should know that closing off the conversation like that does no favours in them seeking help, and they can become totally lost in the crowd, not wanting to bother anyone again with their mental health. I certainly felt that way. I know the first GP wasn’t being rude or malicious in her intent but I felt so invalidated and hopeless.
Don’t be the GP to slam the door in someone’s face. Be the GP that continues that conversation.