Seasonal trends in antidepressant prescribing, depression, anxiety and self-harm in adolescents and young adults

Jack, R.H. et al. | Seasonal trends in antidepressant prescribing, depression, anxiety and self-harm in adolescents and young adults: an open cohort study using English primary care data | BMJ Mental Health 2023; 26: e300855 | http://dx.doi.org/10.1136/bmjment-2023-300855

The objective of this cohort study was to determine whether there are seasonal patterns in primary care antidepressant prescribing and mental health issues in adolescents and young adults.

The findings show an increase in SSRI prescribing, depression and anxiety incidence in male and female adolescents in the autumn months (September–November) that was not seen in older age groups. These higher rates of antidepressant prescribing and consultations for depression and anxiety at the start of the school year among adolescents suggest that support around mental health issues from general practitioners and others should be focused during autumn. Future research should examine whether these patterns are also seen in younger children and those who do not present to GPs.

Full paper: Seasonal trends in antidepressant prescribing, depression, anxiety and self-harm in adolescents and young adults: an open cohort study using English primary care data

Inequalities in mental health care for Gypsy, Roma, and Traveller communities: Identifying best practice

NHS Race and Health Observatory

Gypsy, Roma, and Traveller communities face some of the starkest inequalities in access to healthcare in England and experience dire mental health outcomes.

This report is a comprehensive review that explores a lack of mental health care provision for these communities; captures first hand insight; and highlights good practice examples from six effective services across England, most of them run by voluntary Gypsy, Roma and Traveller organisations. The report contains data, personal interviews and analysis, and includes recommendations for policy, practice and research.

• Main report: Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities – Identifying Best Practice
• Plain English Summary: Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities
• Appendices

Identifying individuals at risk of developing psychosis

Radez, J et al. | Identifying individuals at risk of developing psychosis: A systematic review of the literature in primary care services | Early Intervention in Psychiatry | 2023 May; 17(5): 429-446 | https://doi.org/10.1111/eip.13365

Psychosis and related disorders are a major public health issue. Early identification and prevention for those at high risk (at-risk-mental-state, ARMS) is important. General practitioners (GPs) are often the first point of contact for health services. This review aims to identify (1) the most common methods for identifying individuals with an ARMS in primary care, (2) the methods for improving identification of individuals with an ARMS in primary care, and (3) the most common barriers that prevent GPs from screening for individuals with an ARMS.

Full paper: Identifying individuals at risk of developing psychosis: A systematic review of the literature in primary care services

NHS mental health services: what’s changed?

NHS mental health services: what’s changed? | QualityWatch: Nuffield Trust and Health Foundation

A deterioration in mental health in England during 2020 and 2021 drew attention to how mental health in the country has worsened over time. So how has that affected the NHS? This QualityWatch blog looks at how referrals to mental health services have changed, whether psychological treatment is meeting people’s needs, and the changes there have been in the use of medication.

Full detail: NHS mental health services: what’s changed?

Loneliness campaign 2023

via Department for Digital, Culture, Media and Sport

Following the success of last year’s national campaign, which saw some very positive steps towards people taking action to help feelings of loneliness, the Department for Digital, Culture, Media and Sport will be launching their six week loneliness campaign activity on 30th January.

The campaign primarily aims to reach 16-34 year olds by encouraging them to ‘Lift Someone Out of Loneliness’, knowing that this will likely help their own feelings of loneliness. This is based on recent research that shows that people in this demographic are at higher risk of feeling lonely compared to other age groups, but less likely to seek advice and support.

Full detail and campaign resources: Loneliness campaign 2023

NHS Practitioner Health: Mental Wellbeing App

NHS Practitioner Health has produced a fully customised mental wellbeing app providing access to customised content including tools, resources and routes to support.

The Practitioner Health Mental Wellbeing App is now available to any member of the primary care team. You can register for the app using the access code PC2022 and you will then be sent joining details. The app is a personalised mental wellbeing tool, creating a wellbeing plan based on individual scores and customised content based on your identified needs. The app provides access to self-care information, links to useful resources, other relevant organisations and weekly mental fitness reports and podcasts.

Full detail: NHS Practitioner Health Mental Wellbeing App

Which non-pharmaceutical primary care interventions improve mental health amongst socioeconomically disadvantaged populations?

Tanner, L.M. et al. | British Journal of General Practice | 22 November 2022 | DOI: https://doi.org/10.3399/BJGP.2022.0343

Common mental health disorders (CMDs) are especially prevalent amongst people from socioeconomically disadvantaged backgrounds. Non-pharmaceutical primary care interventions, such as social prescribing and collaborative care, provide alternatives to pharmaceutical treatments for CMDs. Little is known about the impact of these interventions for socioeconomically disadvantaged patients. the aim of this sytematic review was to synthesise evidence for the effects of non-pharmaceutical primary care interventions on CMDs and associated socioeconomic inequalities.

Thirteen studies were included, with positive results (based on effect direction) reported for the impact of the interventions on wellbeing in socioeconomically deprived groups. Inconsistent (mainly positive) results were reported for anxiety and depression.

The authors conclude that targeting non-pharmaceutical primary care interventions at socioeconomically deprived areas may help to reduce inequalities in mental health outcomes. However, only tentative conclusions can be drawn from the evidence in this review and more robust research is required.

Full paper: Which non-pharmaceutical primary care interventions improve mental health amongst socioeconomically disadvantaged populations? Systematic review.

Understanding eating disorders

Health Education England | elearning for healthcare

To support GPs and primary care clinicians in understanding and supporting people of all ages with an eating disorder, Health Education England has worked in partnership with experts by experience, NHS England and the charity Beat to launch two short 30-40 minute online eating disorder learning sessions.

The sessions aim to equip clinicians with the knowledge and skills needed to be able to identify and assess eating disorders. It includes information on providing medical assessment and treatment, referrals and referral pathways to specialist services and the psychological impact of eating disorders on patients, their families and carers.

Full detail:

• GPs and primary care: understanding eating disorders
• GPs and primary care: assessing patients for eating disorders

Depression in adults: treatment and management

National Institute for Health and Care Excellence | Depression in adults: treatment and management | NICE guideline [NG222]

This guideline covers identifying, treating and managing depression in people aged 18 and over. It recommends treatments for first episodes of depression and further-line treatments, and provides advice on preventing relapse, and managing chronic depression, psychotic depression and depression with a coexisting diagnosis of personality disorder.

This guideline updates and replaces NICE guideline CG90 (October 2009). This guideline was previously called depression in adults: recognition and management.

Full detail: Depression in adults: treatment and management

NICE have also created a series of visual summaries to explain the treatment and management of depression in adults:

• Discussing first-line treatments for less severe depression
• Discussing first-line treatments for more severe depression
• Preventing relapse
• Further-line treatment
• Treatment options for chronic depression, depression with personality disorder or psychotic depression
• The matched care model

Young people who have fallen through the mental health transition gap: a qualitative study on primary care support

British Journal of General Practice | Vol. 72 (719): e413-e420 |  DOI: https://doi.org/10.3399/BJGP.2021.0678

Little is known about young people’s experiences of accessing mental health support from their GP after leaving CAMHS. The aim of this study was to explore the experiences and perspectives of young people and the parents/carers of young people receiving primary care support after CAMHS and to identify barriers and facilitators to accessing primary care.

Three themes were identified: unmet mental health needs, disjointed care, and taking responsibility for the young person’s mental health care. Barriers included the perception that GPs couldn’t prescribe certain medication, anxiety caused by the general practice environment, and having to move to a new practice at university. Young people’s positive experiences were more likely to include having a long-term relationship with their GP and finding that their GP made time to understand their needs and experiences.

GPs could help to meet the unmet needs of young people unable to access specialist mental health services after leaving CAMHS. There is a need for comprehensive handover of care from CAMHS to GPs, which could include a joint meeting with the young person and a member of the CAMHS team. Future research should focus on interventions which improve continuity of care for young people after leaving CAMHS, and collaborative working across community mental health services.

Full document: Young people who have fallen through the mental health transition gap: a qualitative study on primary care support