Getting an appointment with a GP can often seem an impossible task but a new report from the Disability Rights Commission has shown that a much wider range of barriers to primary care exist for people with mental health problems and learning difficulties.
The commission is conducting a formal investigation into the health inequalities experienced by people from both these groups and recently published an interim report half way through the 18-month investigation.
The first stage of the study has found that people with learning difficulties or mental health problems are significantly more likely to experience some serious physical illness than other citizens and inequalities in the health services they receive.
An analysis of the records of 1.7 million primary care patients found that those with schizophrenia or bi-polar disorder are more than twice as likely to have epilepsy or diabetes as other patients and that they are also more likely to experience heart disease, stroke, hypertension and epilepsy.
Health check results of 181 people with learning difficulties in Wales were also analysed by the researchers and showed that the group are more likely to be obese, one third compared to around a fifth of the general population, and that this was particularly the case for women.
Paul Corry, director of campaigns and communications at mental health charity Rethink, says that people with severe mental health problems will die on average 10 years younger than members of the general population due to a physical illness. He argues that the groups’ susceptibility to physical health problems is linked to the inequalities they face in accessing health services.
More than a thousand people with mental health problems and/or learning difficulties responded to a questionnaire sent out by the researchers as part of the study and over half said that they had faced difficulties when trying to use the service provided by their health centre or doctor’s surgery.
A small number also spoke about not being registered or being struck off a GP’s list for reasons such as being “too demanding”.
Other findings from the research showed that people with learning difficulties, particularly those with severe difficulties, have much lower rates of cervical screening, mammography and other routine tests than other citizens, while those with mental health problems were less likely to have had blood pressure recordings in relation to heart disease or cholesterol tests in relation to strokes.
“I think there’s reluctance on the part of health professionals to fully engage with people that have mental health problems,” says Corry. “If you go to a GP and you have a diagnosis of a severe mental illness the first thing some think is that this [the physical problem] must be related to it.”
He adds that in this situation doctors will often send such patients to see a psychologist before treating them when this is not appropriate and this subsequently delays the patient getting the correct treatment.
Su Sayer, chief executive of learning difficulty charity United Response, says that people with learning difficulties also report some doctors and nurses seeing them in terms of their disability first.
One of the main barriers cited by the DRC questionnaire’s respondents was perceived negative or discriminatory attitudes by health care staff. Some felt stigmatised or discriminated against while others felt they were not listened to by their GP and were not given adequate time and information.
Corry says that work by the physical disability movement has shown that a lot of discrimination is unintentional and a result of ignorance. He sees this as similar in relation to the discrimination against people with mental health problems arguing that many doctors will think that they are doing the right thing when they refer patients on to psychiatrists.
Liz Sayce, director of policy and communications at the DRC, says that other barriers to primary care reported by respondents included reception staff immediately wanting to know what appointments were for, inflexible appointment programmes and doctors and nurses being seen to talk down to people or ignoring them and only talk to their carer. She added that for those in residential care there were particular problems with some staff being seen as acting as “gate keepers” and preventing people from seeing GPs.
For people with learning difficulties communicating what is wrong with them to healthcare staff can also prove problematic. Sayer says that this is particularly the case when people use non-verbal ways to express themselves and argues that staff training could help to address the issue.
In order to end the inequalities in health services the reports findings suggest that treating everybody as the same will not be sufficient.
“As an absolute minimum people with a learning disability or a mental health problem should get the same level of health care but actually that’s not enough. People need positive action to ensure they get it,” says Sayce.
She explains that this involves doing things differently such as automatically giving people with disabilities double appointment times without them having to ask for them over and over again and allowing people who find it difficult to talk on the phone to book appointments by email. Another example of best practice featured in the report includes providing people with private waiting rooms away from busy reception areas.
Corry argues that the key to improving people with mental health problems’ physical health lies in mainstreaming mental health services into wider social care and health policies. He gives the example of the new GP contract which rewards doctors for carrying out health checks with people with mental health problems as showing how this can be done. “We are hoping that that is going to raise awareness amongst GPs on mental illness,” he said.
Sayce stresses that alongside the badly performing services there are many examples of good practice with some people telling researchers that they had had fantastic experiences of primary care.
Findings from questionnaires sent out to primary care practitioners as part of the study, to which 138 responses were received, illustrate this. Around 10 per cent of practitioners said that they reviewed the health needs of people with mental health problems while the same amount said they were developing registers of people with learning difficulties.
In light of the government’s plans to help one million people to come off incapacity benefit and find work many argue that the need to improve the health of people with learning difficulties and mental health problems will become even more pressing in the future.
“For the welfare to work programs to work this really has to be factored in,” Sayce concludes.
Equal Treatment: Closing the Gap from: www.drc-gb.org/health