Mental Health resource: GP/FP Role in non drug interventions

"Family doctors’ role in providing non-drug interventions (NDIs) for common mental health disorders in primary care" is a new resource produced by the WONCA Working Party on Mental Health, chaired by Prof Chris Dowrick. It was launched at the WONCA Asia Pacific Region Conference this week.

Non-drug interventions for common mental health problems can take a variety of forms ranging from supportive and empathic clinical interpersonal communication techniques and low intensity psychosocial interventions that can be delivered by any family doctor, to more intensive psychological therapies provided by trained therapists. The aim of this guidance paper is to help raise awareness of the role of non-drug interventions (NDIs) in managing common mental health disorders, and to encourage family doctors to incorporate these evidence-based treatments into their routine practice. Our WONCA Working Party have drawn together evidence from the literature to make recommendations on how to promote the use of NDIs with a focus on the training needs of family doctors and recommendations on service delivery models relevant to primary care.

Summary of Recommended Skills

Be able to demonstrate active listening and clinical interpersonal skills to show warmth, interest, respect, empathy and support
• Attentive body language: facial expressions, eye contact, gestures to show engagement and interest
• Following skills: open-ended questions to facilitate the patient to tell their story, attentive silences, facilitative responses, picking up on cues
• Reflecting skills: paraphrasing, summarising or repeating back what has been said to clarify and show understanding, reflect back feelings

Be able to effectively assess a patient’s psycho-social status e.g. using the BATHE technique
• Background: e.g. “What’s going on in your life?”, “Tell me what has been happening?”
• Affect: e.g. “How does that make you feel?”, “How has that affected you”
• Trouble: e.g. “What troubles you about this?”, “what bothers you the most about the situation?”
• Handling: e.g. “How are you handling that?”, “How have you been managing this problem?”
• Empathy: Instil hope by expressing your understanding of what the patient is going through e.g. "I imagine that could be / may be difficult", “You seem to be going through a lot”

Be able to provide psychoeducation
• Be able to provide psychoeducation for depression, anxiety and panic attacks – pathophysiology, effect on health and treatments
• Be able to explain the sleep cycle and its effect on mental health
• Be able to provide instructions on sleep hygiene.

Be able to teach relaxation and stress management techniques
• Be able to teach slow breathing exercises
• Be able to teach progressive muscle relaxation
• Be able to promote and support patients to practice guided relaxation, meditation and/or mindfulness-based interventions

Be able to incorporate principles of behavioural activation into the management plan
• Be able to negotiate with the patient to construct a patient-centred activity plan
• Be able to encourage and motivate a patient to keep engaged in pleasurable activities and activities that can improve self-esteem and self-efficacy
• Be able to motivate patients to keep physical active by maintaining or increasing physical activity
• Be able to facilitate patients to strengthen their social supports

Be able to support patients in using internet-based psychological treatments
• Be able to facilitate and support patients using guided internet based psychological therapies such as iCBT

Be able to empower patients to become better problem solvers
• Be able to facilitate patients to identify specific life problems associated with psychological and/ or somatic symptoms
• Be able to guide patients to set specific, achievable goal/s
• Be able to assist patients to brainstorm possible solutions and weigh their pros and cons
• Be able to empower patients to decide on and implement a realistic plan of action, and to review the outcomes

Download full document 14pp