Counselling in Primary Care — Plymouth's Answer to the Eternal Dilemma
| Pages | 26-28 |
| DOI | https://doi.org/10.1108/13619322199600030 |
| Published date | 01 September 1996 |
| Date | 01 September 1996 |
| Author | Laurie Davidson |
| Subject Matter | Health & social care |
26 The Mental Health Review 1:3 ©Pavilion Publishing (Brighton) 1996
Counselling in Primary Care –
Plymouth’s Answer to the Eternal
Dilemma
FOCUS ON…
Laurie Davidson, Counselling Services
Manager
PLYMOUTH COMMUNITY SERVICES NHS TRUST
The placement of counsellors in the primary
care setting is one solution to the dilemma
faced by almost every mental health service
in the country—how can the careprogramme
approach (CPA) be implemented, with its emphasis
on more seriously mentally ill people, whilst at the
same time providing a service that meets the needs
of GPs. Symptoms of stress, depression and anxiety,
which may involve abuse, bereavement and eating
disorders, are the bread and butter of the doctor’s
surgery.
Efforts to solve this dilemma have usually
centred on community mental health teams (CMHTs)
trying to balance priorities against incompatible
pressures. It has been left to provider teams to sort
out the problem when, in fact, the dilemma belongs
with the purchaser. Shifting resources from secondary
to primary care will simply remove resources from
the CPA and the problem will shift — but not be
solved. New money must be found to take away
inappropriate referrals from specialist mental health
teams to deal with them in the primary care setting,
with the added benefits of convenience for the
practice patient and reduced stigmatisation. There
have been a variety of responses: CPNs, psycholo-
gists, social workers, systemic therapists or brief
therapists, counsellors who work for agencies directly
contracted by health commission, counsellors who
work directly to the practices in a mixed model of
provision and even private CPN services. The
choice of model may be for political, pragmatic or
considered therapeutic reasons. Nationally, there is
no one preferred model.
The Plymouth model
During 1994, local CMHTs were experiencing
acommon phenomenon. Referrals werebeing
received at an alarming rate from GPs. Despite the
best efforts of the teams to prioritise and the full
implementation of CPAby the end of 1994, a large
amount of time was being spent on assessing and
counselling people who fell outside of the local CPA
criteria. Referrals were being returned to GPs, who
became annoyed at being left with the responsibility
for people who wereclearly distressed and in need.
Many practices employed their own counsellors with
partial funding from the FHSA or through their own
funds.
New money was identified for a pilot service
based in the inner city. A later decision was made
to fund a blanket service to non-fundholders of one
counselling hour per 1,000 practice population per
week. Fundholders could buy into the service. The
counselling service was placed within the Primary
Care Directorate rather than the Mental Health
Directorate, which enabled a very swift develop-
ment of the service, free from the history of an
established service. A counselling services manager
was appointed in January 1995; an operational
policy, guidelines on access criteria and other
personnel and financial matters werein place
before the appointment of counsellors in April 1995.
At that time, therewere40 non-fundholding
practices without a counsellor.Thirteen practices
already had a counsellor and when the counselling
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