Depression and recovery in Australia
Experiences with health professionals: General Practitioners (GPs)
GPs are frequently the first point of contact for people seeking help for mental health issues. Experiences with GPs varied amongst the people we spoke with. Most people consulted GPs for their emotional distress, particularly in the initial period when they were trying to understand what was happening to them and obtain a diagnosis. Only a couple of people saw neither a GP nor any other medical professional for their depression. People also looked to GPs for information about available treatments, prescribing antidepressant medication, and referrals to other health professionals.
Some GPs with a special interest in mental health provided counselling, along with pharmacological treatments. Many people had taken the opportunity to develop mental health plans with their GP and subsidised counselling sessions with a registered psychologist through the government funded 'Better Outcomes in Mental Health Care' programme or 'Better Access to Psychiatrists, Psychologists and GPs' initiative. A few people who had migrated to Australia mentioned appreciating GPs who spoke the same language or came from a similar ethno-cultural background as this was helpful in understanding cultural expression of emotional distress and norms around addressing such distress.
For most people, the gender and age of their GP was less important than the way they treated them as a patient. However, a few younger people emphasised seeing GPs that were ‘good with young people’. As Troy said of his GP, ‘we'll go see him because he’ll know what he's doing, and he was good and he was lovely and I'd go back to him any day’. Desirable qualities or aspects of GPs included' a long-term relationship and awareness of their patients’ life circumstances and problems, listening and understanding, willingness to experiment with different medications and therapies, and treating patients with dignity. A few people appreciated GPs who were additionally qualified in mental health, as expressed by Debra who said: ‘You need a doctor maybe that's got a bit of empathy, maybe done some studying in mental health as well’. Other important qualities mentioned were noticing signs, asking the right questions, and reassuring patients that depression can be treated, but it may take time to get better.
Some people had a long history of mental health issues, sometimes having more than one diagnosis. Over several years, they had been prescribed many different medications by their GPs and these experiences had not always been positive. One woman believed her initial treatment with a particular medication was unnecessary and made her feel dependent on it. Ron described being prescribed antidepressants by his GP when he was first diagnosed with depression in the 1980s, without being given any explanation about the condition or the medication. As he put it, ‘...he didn’t seem to want to hear me, "just take these pills"’. Gabrielle recounted a past experience of a locum GP leaving her with a large quantity of antidepressants while she was breastfeeding and feeling suicidal.
Gabrielle described a GP she saw while experiencing perinatal depression who was both helpful and...
Gabrielle described a GP she saw while experiencing perinatal depression who was both helpful and...
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Having - oh yes, you've got to have - goodness yeah. You wouldn't get through it otherwise. When you're that unwell you're constantly ringing - you don’t know what you're doing. You're crying, you're, having panic attacks, you're, doctor - oh. I remember one GP came out to me and I was, very unwell. And he said to me look, I'll get someone in to do your vacuuming, and I'll leave you with these tablets. And it was very inappropriate. The medication - I was breastfeeding, and they were tablets that weren’t too good for the baby. And he left me with a huge box full, and I was suicidal.
So that scared me even more [laughs]. Like, so, if you're a worrier and you, - just inadequate things. That was 20 years ago. I don’t think that - I hope to God that wouldn't happen now. I had the sense to give the tablets to someone and say take them away.
It was also important for people’s experiences to be acknowledged and validated. Some people objected to being told by their GPs that they did not have depression when they believed they did, while others had the opposite experience of being diagnosed with depression and feeling pressured to take antidepressants when presenting for physical health problems.
Louise spoke about an experience of a GP who dismissed her worries about her depression returning...
Louise spoke about an experience of a GP who dismissed her worries about her depression returning...
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But I do remember a doctor - not my normal doctor - it was one of his replacements - and I went to him one time and I said I think I have depression again and he said what have you got to be depressed about and really, that's the last thing you want to hear, because you could have on the outside everything going for you. But inside your mind and your spirit and all of that and your emotions are just in absolute turmoil. So for someone to say that is not helpful at all and it puts pressure on you to those expectations again of well what have you got to be depressed about? You should be happy. You've got this and you've got that.
Belinda spoke about feeling stigmatised by a GP who insisted she was depressed then made...
Belinda spoke about feeling stigmatised by a GP who insisted she was depressed then made...
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I think it was about 2001 or 2002; I had gone to a GP because of a completely different health issue. I had some sort of you know health issue I was worried about and I was quite anxious about it. And when the GP saw me I was crying and I said to her I am really worried about this particular lump I have. And she said to me, no I don’t think you need to worry but what else has happened that is making you so upset. I said, well, I saw you know an ex-boyfriend last night at a function and he was with his new girlfriend and you know it was a bit of a shock for me; I found that quite difficult to deal with.
And she said to me, well you are clearly depressed…You, no. First thing she said to me, did you sleep last night, and I said no, because I didn’t, because I’d seen an ex-boyfriend with you know looking very happy you know with his current girlfriend and that made me sad, so I hadn’t slept. She said did you eat last night, and that night before I hadn’t eaten. And she said well you are clearly depressed because you haven’t slept and you haven’t eaten and therefore you are suffering from depression and I want you to go back on to Zoloft. And I remember saying to her, look, I really don’t think that this is necessary. I’m being, you know, really greatly supported by at that stage a psychologist, like really greatly supported by her and I was seeing her regularly and I was doing, you know, eating healthily and trying to look after myself, but she was, this GP was particularly insistent that I take her prescription. And I had said, no, I had said no about three times. In the end she said to me, I don’t know what’s wrong with depressed people, why they always refuse to take my prescriptions. I think depressed people like being depressed.
I felt like she’d shamed me into taking her prescription. So I took it. And I was, I think anybody could have seen how upset I was. That I was, I thought I was really being forced to do this. And then when I took it she said to me, well that wasn’t very hard, was it, and I thought well it’s actually really hard. I don’t want this. And I took it home, and I was living with my mum at the time and my mum, my mum took it from me and said don’t fill it, you don’t need it and you don’t fill it. I don’t want you to have to worry about that sort of thing. It was only because my mother said to me and, you know, mum is pretty conservative and, she is a nurse by training, and she normally agrees with what doctors say but she said to me, no, I don’t want you doing it. If you say you don’t want to do it, then you shouldn’t have to do it.
And that was, that’s quite a big thing for me in my, you know, in my experience with depression. That particular experience with that GP has really makes me quite angry; that somebody who I had gone to you know and you know, who I wanted to seek advice for, from something completely different as well, sort of turned it around and sort of caused me to feel stigmatised about you know something that I’m you know that I live with and it’s okay. You know I don’t think there is anything wrong with having depression at all. Or know that I, you know that.
She says I have depression so I am assuming it’s the medical sort of diagnosis, you know, but it does, it does make me a little bit angry and frustrated that somebody in that position of power was able to do that to me, and I am pretty assertive even when I am feeling low, you know, I can still be pretty assertive.
Some people had multiple health and allied health professionals involved in their depression care. In such cases, it was seen as important for the GP and other health practitioners to be ‘on the same page’ for the patient to feel comfortable about their treatment. This was not always simple to achieve however.
Debra described the process of bringing her GP and other mental health care providers into...
Debra described the process of bringing her GP and other mental health care providers into...
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Well the GP originally diagnosed the postnatal depression but that had, I'd, gone, you know, I wasn't in postnatal depression at the time. The GP basically referred me to the psychologist and also the psychiatrist and that's pretty much all he did really. He, the only other thing he did was the medication side of things. So I was getting counselling from the psychologist. I was seeing the psychiatrist for medication and they were trying me on different sorts of medication and then I was seeing the GP to get the medication. So the GP was really only the dispensary I suppose for the medication. But I was seeing the psychologist and the psychiatrist.
Before, in December when I was about the leukaemia he was very, very supportive there as well. I was in such a state that they were going to inject me with Valium because unfortunately - well there's a story I guess there. Unfortunately my GP and I haven't been completely on the same page with my mental health plan. Because he has the responsibility of prescribing the medication, so I completely understand that side of things but I completely also trust my psychologist.
So if my psychologist and I come to certain agreements with certain things, whether it be psychotherapy, whether it be medication, it's been hard to transfer that into the GP type, type of things as well.
Especially when it comes to the benzo - because, you know, GPs are encouraged not to prescribe the benzos. But my psychologist and I have a plan for the hurdle that I seem to create for myself in coming off the benzo. We're looking at it more as a journey now rather than an achievement or something like that. It's taken a bit for me to feel that my GP is on the same page with my mental illness as what my psychologist and I are. But we are now on the same page so that's good. Because my psychologist actually came in and had an appointment with myself and the GP and it was around about December.
Akello talked about feeling ‘let down’ when a GP she found very helpful left the practice. As she was not happy with the other GP she was referred to within the same practice, she searched for another doctor until she found one she was satisfied with.
After her GP left the practice, Akello considered herself 'lucky' to find another one she liked....
After her GP left the practice, Akello considered herself 'lucky' to find another one she liked....
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The first GP I liked – I would talk to her the way I am talking to you, you know. she doesn’t have this air that I’m a doctor, I’m a medical doctor, I’m well learned, I’m very clever to be doing this, you know, sort of thing. She was so down to earth. And she’d also been seeing my children when they are like ill and she would laugh.
You know one day I took my son to see her and she just laughed and she - I said why are you laughing? She said, he’s got such an Australian accent, you know, he speaks - my children all speak like Australians. And I found that more relaxing. It’s not, you know, she made me - it’s like she released the tension I would be having and she didn’t make me feel like I’m much more sick than I thought I was, you know.
When I got out I would feel like I’m getting better immediately, not - normally when I get out of the doctors, some doctors, I feel like okay, what did he say to me and I feel like, ah I really didn’t understand this, I didn’t get this. But she seemed to understand me well, so - I maybe also just, just biased because she was not, she was - I thought she understood me better, she’s not an Australian. She’s not of Australian origin.
Some people we talked with described having had a friendly relationship with their GP prior to needing help for depression. This then became a barrier as they did not feel comfortable discussing certain matters related to their distress. Amelia said she had to stop seeing her long-term GP after an incident that left her with the impression that her GP also suffered from emotional distress, while Kim Hai did not want to admit to her GP her advice had been unhelpful.
Kim Hai saw a GP from the same background who was also a friend. This made her reluctant to tell her that her advice had been unhelpful, so instead Kim Hai changed GPs.
Kim Hai saw a GP from the same background who was also a friend. This made her reluctant to tell her that her advice had been unhelpful, so instead Kim Hai changed GPs.
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I did go back to her as a patient for some antidepressant for depression because after the interview I thought, oh, how miraculous you know these tablets are. I must try, because I was feeling like quite down at that time, not letting you know my husband and my son know, though. I just said I have to go to see (doctor’s name) for an interview, so I just went, and she was very good. She advised me on how to behave in my marriage to, you know, culturally appropriate way - I tell you about that later; it didn't work for me, though – to save our marriage.
And then I went and took a different antidepressant.
Who gave me that? I try to remember who gave me - I think (another GP) actually gave me some lighter one. I talked to her. I didn't want to go back to (doctor’s name) to say that, because you know she and me we were friends. I didn't want to offend her. But I did talk to her on the phone and said your advice, you know, I try it. It was good for a while but it didn't really work, and she didn't ask me whether I take the drugs or not. If she had asked me I wouldn't have lied, though.
GPs being inflexible, overly authoritarian, patronising, or not listening to patients’ views about treatments were qualities or behaviours that people particularly disliked. In contrast, people who took a more active approach to their depression care and had a good relationship with their GPs reported engaging in honest discussions with them.
Colin valued his GP's willingness to engage in discussion about things he viewed as important.
Colin valued his GP's willingness to engage in discussion about things he viewed as important.
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I’m reasonably analytical. I like to find out what’s wrong, what caused it, how can I fix it up and I go - I will go through those things. My GP says, ‘You’re a very hard man because you want to ask all those questions’. Of course, and that’s what we should do because he did - he was also a big help to me because he real - he understood that I wanted to know why these things had happened, how we were going to fix it and how we can prevent it from happening.
When people found a GP whom they liked, these relationships were described as a key source of professional support. Additional qualities in GPs people appreciated were compassion, a sense of shared life experiences (e.g. motherhood, migration, shared language or cultural background), extended consultation time when needed, trusting people's judgements and decision-making ability, giving people choices about preferred treatments, and understanding what people go through in coming to terms with their mental health condition and diagnosis.
Rosie described her GP as her 'lifeline'.
Rosie described her GP as her 'lifeline'.
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I think what was helpful was probably two, three things. One, she listened. She just listened. Two, she cried with me because she could feel. I think that empathy was really important. And three, she gave me a cuddle each time. So you know, I would have sat there for half an hour or an hour and just poured my heart out and she just listened the whole time and at the end with tears in her eyes, she just - and she was smaller than me in height and littler and so I felt like I was giving her a big bear hug and smoth - strangling her because I sort of wanted that contact, that you know, someone cared. That’s what she did. She cared.
She could have been a doctor and she could have stayed removed but because I guess she was a mum and a female, she could understand. She could put herself in my shoes you know to some extent and she knew. She knew my body wasn’t coping so she was able to, you know, to work with it. She was gentle, she wasn’t pushy. She didn’t sit there and say, I think you must go on anti-depressants. She gave me the choice.
And she said, this is my opinion, I don’t think at this stage, you’re very strong, you’re dealing, you’re this, you’re that so I don’t think you need to but if you want to I’m more than happy.
Stephanie appreciated being trusted by her GP and interpreted this as meaning her doctor saw her...
Stephanie appreciated being trusted by her GP and interpreted this as meaning her doctor saw her...
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But I, with health professionals I decided to be very straight with how I felt. When I was overseas I wasn't because I didn't know how I felt, I don't think. But once I'd been I think that when I actually started recovering was when I was back in Australia and I found this doctor who was just graduated, just got her GP qualifications, and she was great because she really listened. And so I didn't, didn't let her go, you know, and I, I just went to her - well when the first time I went to her was when I had to get my script filled and I said well, I've been on this medication, I need to continue taking it because there's no way I'm stopping it, otherwise it's, it's a real problem.
And she handed me the script and I looked at it and I said this is for six months, what are you doing? And she said well, I think that you're a, you know, intelligent person and if you have a problem I'm sure you'll come and see me again. And I nearly fainted because overseas I'd been having to go back every month to get my script filled again because they wanted to check on me and things. And that, I think that for me made me feel like hey, I'm doing okay, and ah so she was really good like that.
And then if I had a problem, because I had a few other, you know, health problems and whenever I went to see her she really listened and she always gave me the options. And she was good that she said, you're going to Google it anyway, so I'll explain it to you, I'll explain it to you. And I said well actually, I don't Google too much stuff because it's, you just get ridiculous amounts of information that is probably not that useful for me.
Stewart emphasised the importance of GPs having an interest in and knowledge of depression. He...
Stewart emphasised the importance of GPs having an interest in and knowledge of depression. He...
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And so she made an appointment with the, with the GP at the clinic where we take the kids, who has an interest in, in depression, a lady GP. And uh I went and saw her a couple of days later and [wife] came with me. And she had me fill out, you know, there's a couple of questionnaires you have to fill out and all of that and we talked about a whole range of issues. She it was just a, it was a, well it was life changing appointment, it really was. I mean she clearly understands the illness and to me she also very clearly understands the issues with people accepting they have the illness.
And we talked through a whole range of stuff and, and it was, and she was asking me questions about my thoughts and, and it was like she could read my mind. She was saying, you know, do you ever think about this and do you ever think? And everything she raised I was like, well yeah, I do
So very important, good GPs. I mean you know there's a lot of ordinary ones out there but gee when you find a good one, it's…
Suzi described her respect for her GP as instrumental in her not acting on her suicidal thoughts...
Suzi described her respect for her GP as instrumental in her not acting on her suicidal thoughts...
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Yeah, I did back then. I can’t even remember now what the, what the plan was then but… yes this GP sports medicine doctor that had been so absolutely wonderful to me and even let me ring him at home and stuff, he wanted me to see someone, a psychiatrist and I was so much against it. And… but when I was so sure that I was going to take my life, I thought about him and I thought, gee people are going to turn round when I kill myself and say, ‘How arrogant were you that you were looking after her and didn’t send her to a psychiatrist’. And I didn’t want him to wear all that. And I didn’t know who to go to. I eventually said, ‘Yes all right I’ll go’. And he said, ‘Well who do you want to go to?’ I said, ‘I don’t know, I don’t know anyone’, so I let him choose someone.
Last reviewed January 2016.
Last updated January 2016.
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