Mental health: ethnic minority carers’ experiences

Working with GPs and Psychiatric Consultants

For many carers the GP (general practitioner) is the first port of call when seeking help for the person they care for. A GP can prescribe medicines, be someone to talk to and discuss different options with. GPs can also sign a patient off work, and refer them to other parts of the health service such as psychiatrists (but waiting lists can be long). GPs can also refer directly to talking therapy services.

Psychiatrists are doctors specialising in mental and emotional problems. They can diagnose mental health conditions and prescribe medicines and other treatment such as psychotherapy and CBT (Cognitive Behavioural Therapy). Some psychiatrists are part of 'community mental health teams'. People also meet psychiatrists as inpatients or outpatients in a psychiatric hospital.

The carers we spoke to were usually involved in the medical care of their relative and thought it was important to work well with GPs and psychiatrists. While some doctors were skilled at working with carers and patients, carers did have some reservations about the roles of doctors as explained below. See also 'Carers' voice and confidentiality issues'.

Relationships with doctors
Many of the carers came along to doctors' appointments with the person they cared for. Most said that ideally there would be a good working partnership between doctors and carers and that the expertise of carers, as well as of doctors should be recognised.

Some had put a lot of work into building up good relationships with doctors over the years. They emphasised the importance of managing their relationship with doctors. For instance, they said it can help to let clinicians know you are not 'against them' or 'bashing the system.' Others said you have to be careful when telling a doctor they are not doing things well.

Over the years he has developed a good relationship with his GP.

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Age at interview: 63

Sex: Male

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And I've got a good GP, she's very, very good, lovely lady, doctor, Mrs. [name], and she has told me if I've got any problem to come and tell her, and she will try to deal with it. Sometimes a carer company will try their luck by trying to cut down on certain services, then, as soon as I notice it, I said, hold on what are you trying to do? Then there's a bit of argument, then I tell them look I don't want to argue, are you going to do it or not? If you're not going to do it, I know how I can make you to do it, and then all that I do is ring the GP, and the GP rings up, that's it problem solved, you know, this is it.

How did you get that good relationship with your GP?

Well firstly when we registered with the GP she was a lovely lady, and also we are from Sri Lanka, we respect the doctors and everybody, we don't throw our weight about, you know, we respect them, and if you respect them and treat somebody kindly they will reciprocate. I remember once I went to the surgery, and there was a new receptionist, so I nicely asked her, she said, 'why are you nice to us, normally people are nasty, we are a bit puzzled', you know, that sort of a business? So we built up over the years a very good relationship, you know, so no problem, and also I read in the newspapers GP's and some of the doctors, their job is quite stressful, people come along and tell them the tale of woe and the problems. And I read some statistics that half of them become alcoholics, drug addicts, suffer from mental illness, so that sort of a business. So you also have to understand, they have problem as well, you know, but she's good. Tomorrow she leaves, and if we get another GP who's not very good, then I go and change it, I'm not going to put up with it, yeah.

Several carers said their doctors were supportive, reassuring, took time to listen to them and helped them 'get the appropriate help at appropriate times'. Several said that at six-monthly psychiatric consultations, the psychiatrist was careful to listen to both the carer and the person who was unwell.

Several carers said their doctor had helped find flexible solutions for medication. For instance, one GP had made it possible for the carer to collect her brother's medicine from a local pharmacist every week. Another GP offered to organise injections for a carer's son when he was visiting.

However, others had found doctors less helpful. For instance, many said that doctors did not listen or involve carers enough in decisions about treatment and care. Doctors were also criticised for talking in ways that were too negative or even like 'a hopeless kind of condemnation,' such as telling carers 'point blank' that their loved one would never recover, or not to 'expect miracles'. These people said doctors need to talk in more respectful ways, and use language people could understand.

Many carers felt that doctors did not give them enough information when they first became carers and others said that some doctors 'hide' behind patient confidentiality and didn't want to engage with carers .

The doctors did not tell Nick about the tests that should have been done on his son or the...

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The doctors did not tell Nick about the tests that should have been done on his son or the...

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Age at interview: 74

Sex: Male

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The psychiatrist heard our story having seen Nathan separately and then advised us to send him back to university to continue his studies as there was nothing to be concerned about. He gave us no advice but we know now that a blood and urine test for drugs should have been carried out at the time.

The two clinicians, who did not take notes - perhaps because they had already decided to discharge our son - stared blankly at us, perhaps implying that everything my wife and I said was a figment of our fertile imagination. We didn't know then that we could have asked for a second opinion and weren't made aware of it either by the consultant - who later told us that cannabis could not have contributed to Nathan's illness!

Availability and continuity of doctors
People said it could be difficult to get to talk to doctors, particularly psychiatrists. One carer even said that his son's psychiatrist had pretended not to be in when he had an appointment to see him!

Many found it frustrating that doctors made decisions based on very little time with the carer or the person with mental health problems. One man said that 'the bus driver knows him better' than his psychiatrist.

People were especially concerned about the lack of doctors available during crises and emergencies. One man said the psychiatrist saw his son only nine days after a suicide attempt, and others talked about how sometimes, during a crisis, the police are their only option to get help (see 'Services in the community').

Anne says it can be very difficult to get psychiatric help in an emergency.

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Age at interview: 40

Sex: Female

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So you've got some contact, and talk with you etc, so it's that help in the home to stop you going into hospital, but you try and access that and it's, you know, impossible. Or one of them will say, you go to casualty because you've taken an overdose, wait for about six hours for a psychiatric assessment and then they'll say, 'oh yeah we'll get the crisis team in. They'll come round tomorrow'. Then you think, and that's your only hope, that's his only hope. And that's, -he's focusing on that. 'Someone's coming to see me tomorrow'. So you get through the next 24 hours, sedatives and, well 'someone's, be coming soon, let's see what they say'. And then nobody comes. And then you phone them up and they say, 'oh no, it's not, we're not down, we have to do our own assessment'. And then they'll come and then they'll see, and then they'll look and they go, 'oh well you've got the carer support worker that comes. You've got Crossroads that come. You go to the project on a Friday so you don't need our help. You've got support'. I think, 'no, he's entitled to that support', -doesn't mean to say he's not entitled to crisis resolution team as well, just because he's got some support. So some of them will try and fob you off as soon as they think you've got any support whatsoever. So don't be ashamed to, you're entitled to, whatever service you're entitled to, you are entitled to it. Don't let somebody condemn you because you're getting some support, you're entitled to more.

Many carers said that their relative was seen by a different GP or psychiatrist almost every time they had a consultation, which made it difficult to build good working relationships. One carer thought that a lack of continuity and communication between doctors resulted in her sister taking twelve different prescribed medications at the same time. She felt both she and her sister had been 'let down' and that doctors 'protect their own' when something goes wrong.

Sophie discovered that her sister was on a very large 'cocktail of drugs' and wonders why this was allowed to happen.

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Age at interview: 42

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She started talking about feeling depressed and that's what I was, -this is what I've been told and she'd been moved from home, well not homes, it's not homes any more, it was residential care from different places to different places, she hates changes, and only to find out that, you know, as soon as she's moved and in new environment, she becomes quite agitated and with her being agitated and upset she's been given medication and she's gone through lots and lots of different psychologists and psychiatrists. She never really stayed with one particular one for a number of years, it was always different, different ones, therefore medication was added and GPs added this and added that until things got really, really bad up until two years ago when I came, well when I was, -when I decided well I need to take part in this and see what's really going on because I had my own issues, I'd been divorced after all that and I was sorting out my life and only just to realise that she was in a state, it was, I mean an utter and total state with medication. By the time I sat down with the carers who were caring for her, the, -the Social Services who were caring for her and found out about the medication and her notes and got all her notes together, what I could get together, I was absolutely mortified at the amount of, eh, medication that she was taking. She was on at least 12 different medications. I have lists of them at home and...

What kind of medication, were they sedatives or...

There were sedatives, there were Haloperidol, there was… -all kinds, I'm only getting used to some of the names of them but there was masses and masses of medication and the medication had turned her into a virtual zombie. She'd ballooned up to size, eh, to over 22 stones, she's unable to do anything for herself and she was just totally comotised and it wasn't until I stepped in and said, well what's all this about, why are people giving her medication, what's the diagnosis? It was that kind of stuff that I had to get in there and try to find out and… I, -there was lots of stuff I had to sit down and say well, hold on now, why is this being given to her at this particular time, what's the diagnosis? I even met with officials, you know, and tried to get a clear understanding of, something had gone wrong because the final stages was, is that the people who were caring for her, who were kind of looking about her interests were saying, and some of the, one of the last psychiatrists that she'd seen had saying, 'I'm sorry she's on a cocktail of drugs that she shouldn't really be on'. Now this is what he said to me so inevitably they decided well, we have to do something about her and take her off all this medication and wean her off all this medication so we can find out what the situation is. So, you know, it's, -when I'm trying to say, well somebody must be responsible for all this.

Doctors' involvement
While some doctors were clearly engaged in patient care, some carers felt many doctors could be more involved. Suggestions here included that doctors should be more willing to do home visits, especially when the person who is unwell doesn't want to cooperate. A few mentioned that GPs could be more involved in early interventions and some suggested that having mental health workers based in doctors' surgeries could increase the involvement of doctors.

He says GPs should know more about how to pick up on mental health problems.

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Age at interview: 74

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And the other thing is where they can pick it up early is at the GP's surgery. How many GPs are aware of mental health? How many are qualified? It's a minority, absolute minority. If they did their job properly they can pick this up very early. Early intervention is worth it you know, thousands and thousands of pounds when it comes to doing calculation on the disasters those thing cause. You can pick it up early and treat it early and stop the nonsense. You see, GP's are self employed people. They only do what pays them better. They don't know or they are not interested, not really interested in mental health. Those who are, are excellent. I know a few who are absolutely marvellous. But this is the problem we have.

One woman had been told by her son's psychiatrist that 'now that he is stable he can be seen by his GP'. She was unhappy because she thought psychiatrists and not GPs would keep up with the latest treatments for mental health problems.

Sarah wishes the psychiatrist would be more involved in her son's case (played by an actor).

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Age at interview: 59

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And that's really what you've got to remind yourself. And because obviously the ideal situation is to be able to work in a team with, -but to be more involved, I think I would, you know, and probably they would think I have been very involved, because I involve myself, but I would have liked more, much more. I mean you only see the psychiatrist once every six months. I know you can see him if you feel there is a problem, but we don't. And, you know, I think, 'I wish they had more time'. Which is something obviously they can't do much about that, but I wish they had more time, really. So. Because I know that the next stage will be to -probably when he sees next the psychiatrist, he's going to say 'you are stable now, so now, next stage, you are going to be on to the GP', I'm not terribly happy with that, because I feel, -it's not that I feel, you know, that he sees the psychiatrist once every six months, he gets his tablets, but so it's not, but I feel if there is anything new that could happen, it's not going to be through the GP, it's going to be through the psychiatrist. And I feel, -because at the moment I go and collect his tablets, because otherwise he would not go, but so I feel really I am not too happy about that, but we'll see how it goes.

One carer was concerned that no one talked to her about whether her son might get better or worse. She felt doctors thought 'as long as he's quiet in a corner he's not causing any trouble.' To her the doctors seemed to aim at 'being stable' rather than recovery (see 'Carers' views on treatment and cure').

Last reviewed September 2018.

Last updated June 2015.