How online triage can support mental health issues

Mental health issues have always been a common reason for patients to consult with their GP, but over the last year COVID-19 has caused disruption to so many lives, and the number of people seeking help for their mental health, has increased.

A survey carried out by mental health charity Mind in 2018 suggested that approximately 40% of all GP appointments now involve some element of mental health support. We knew we could do more to help, so after feedback from customers and patients, we have reviewed and updated our mental health offering. We’ve been delighted with the positive feedback shared with us by patients about how this is helping them to get the care they need.

My husband has had increasingly poor mental health for the last two years following the death of his sister. He has accessed bereavement counselling, talking therapies and different antidepressants but his anxiety and depression have steadily worsened, to the point he has resigned from work following long periods of sick leave. He has had regular GP appointments for these two years but struggles to share the severity of his symptoms and the extent to which he is struggling to function. This is incredibly difficult for me. Recently, with his consent, I helped write an eConsult where I was able to be honest about how unwell he is and list the worst of his symptoms. His GP responded with a referral to the community mental health team for psychiatric input. This is a huge relief to us both that he will finally get the support he needs. Without eConsult, I would not have been able to share the details and use the vocabulary needed to convey the seriousness of the situation. I am incredibly grateful to have had eConsult as a tool to get my husband the help he needs.
Jess from Livepool

The benefits for patients and practices

Using eConsult as a means to make a request to a GP practice benefits both patients and the care that the practice can provide to their patients in return. From the patient feedback we receive, patients making mental health-related submissions mentioned several benefits:

An increased amount of time they have while using eConsult to think about and explain their condition or request before making it.
The ability to put in the request in writing without having to speak directly to someone, which might itself have been causing the anxiety
The possibility that it has saved them a trip into the practice, especially if they have anxieties around leaving the house, travelling on public transport or interacting with others.

“eConsult has literally been a lifesaver for me. I can’t ring the practice as my anxiety is extreme. This service is amazing, it’s an amazing tool to be resourced by your practice”
Anonymous eConsult patient user

“I very rarely leave my home because of anxiety issues. I also find it hard to explain what is going on with me because there are a lot of different problems. Sometimes on the phone I’ll forget or be embarrassed to say something so being able to write it helps me a lot.”
Anonymous eConsult patient user

Self-help information and local referral services are also available to patients through eConsult, so even if they are not wanting to consult with their practice, they can find out more about their symptoms or condition, and where they can go for the most appropriate help.

“I found using eConsult very helpful to disclose anxiety and personal issues. I would have struggled to explain them at triage for an appointment and when attending an appointment where I’d have to be discussing them face to face.”
Anonymous eConsult patient user

It’s not just patients who feel the benefit of having time to think about the request they are making to the practice, but this has a knock-on impact for the clinicians in the practice as well. By having the patient’s information upfront and in an easy to read format, they can use the eConsult report alongside the patient record to monitor changes in the patient as well as to better understand their concerns.

“The level of information that we get from having patients complete both free text and more structured questions is excellent. Where this has come to light is in mental health consultations. We’ve had patients really open up in terms of their personal situation, relationships, work, hobbies and exercise because eConsult specifically asks about these things. It gives them a chance to offload and these are things that might not come up within a normal 10-minute consultation. It’s giving them a chance to expand on how they’re feeling.”
Dr Rizwan Hussain, Blackwood Medical Group

eConsult’s mental health questionnaires

Across all eConsults submitted we see that around 6% of all specific clinical requests are from mental health-specific questionnaires. We currently have specific mental health questionnaires for:

Anxiety
Depression
Low mood
Panic attacks.

These questionnaires ask patients questions that are usually contained with the Patient Health Questionnaire and General Anxiety Disorder Questionnaires (PHQ-9 and GAD-7) as part of the information they are asked to provide upfront.

Normally, a patient would be asked to attend a face to face appointment to fill out these questionnaires or be sent a paper copy to complete. These questionnaires are often used as screening tools and severity measures for generalised anxiety disorder and depression.

With eConsult, the patient can answer the questions honestly, in their own time and environment before a consultation. The results are factored into the report that the practice receives and the scores are signposted for the person reviewing the report. This means that the practice can take the results of these questionnaires into account when deciding on a treatment plan and response to each patient.

The number of patients requesting support, care or advice around mental health is increasing and we have seen this across the eConsult platform too. While our 6% may seem low it does not take into account patients who have completed a ‘general advice’ questionnaire instead of a symptom or condition-specific one.

Clinical review questionnaires for existing or ongoing conditions

As well as these condition-specific questionnaires, in April 2021 we launched a new ‘Depression and/or anxiety review’ questionnaire. This review questionnaire is designed for those patients who either require a routine annual review of their mental health or for an interim review for those patients who have recently been diagnosed with depression or anxiety.

This new review questionnaire is more concise than the specific questionnaires mentioned above. It includes all the relevant health and lifestyle data that can be included in the Quality and Outcomes Framework (QOF) such as a suicidal risk assessment, PHQ-9 and/or GAD-7 questions, medication compliance and side effects, smoking and alcohol data.

We anticipate that this new questionnaire will be very popular and we hope that it will help to support GPs in reviewing and monitoring their mental health patients and improve their care.

Unsure how to share review questionnaires with your patients?

Read our quick guide to help free up your review appointment slots

We have a growing list of Clinical Review Questionnaires

Clinical review questionnaire eConsults can be very useful in collecting up to date review information from patients with long term conditions or patients who need a contraceptive pill review. In each instance sending the patient a clinical review questionnaire first may result in saving the patient and the practice time and energy.

Find out which other clinical review questionnaires we have and how they could help you care for your patients by following the steps above. Currently, we have:

Asthma review
Blood pressure review
COPD review
Contraceptive pill review
Depression or Anxiety review
Diabetes review
HRT review
Medication review
Thyroid review.

If you have any feedback or suggestions about our mental health or review questionnaires, please do get in touch.