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Mind, body and soul

8 February 2016

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Suicide is the leading cause of death in England and Wales for young men. The male population is notorious for not seeking help, but Victoria Medical Centre in Westminster took matters into its own hands to tackle the situation head on

Building a strong relationship between a general practice and its patients is no easy task, but reaching the male population to discuss mental health issues is perhaps an even greater challenge. Victoria Medical Centre in Westminster, London, has been praised by the Care Quality Commission (CQC) for its drive to reach patients who are often isolated in society. And in particular for its study titled Atlas that was aimed to help men deal with stress-related issues.  
The name derives from Greek mythology. A Titan named Atlas led a rebellion against Zeus. As punishment he was condemned to bear the heavens upon his shoulders forever. Thus, Atlas is often depicted in contemporary art as having the weight of the world on his shoulders.
Dr Susan Rankine, a GP partner at the practice, explains how Atlas made a difference to the patients and the practice, and has also raised the profile of the surgery.   
The idea behind the study originated in 2011 after the charity section of Nelsons, a family-owned business and manufacturer of natural healthcare products, had previously funded the practice for a study on back pain. A member from the practice’s patient participation group (PPG) liaised with several charities and was aware that “charities have got certain amounts of money and they want to spend it on doing things for health and provide exemplars,” says Rankine. After the success of the back pain study it was decided that mental health should be the next focus and Nelsons funded the study that was co-designed between Victoria Medical Centre and Professor David Peters from Westminster University.
The research was designed to help men between the ages of 20 to 40 deal with stress and mental health issues. It ran for 18 months and finished in July 2014. According to Rankine, it was important that “it wasn’t called counselling for depression; it was to help with stress and stress management”.  
Rankine, the GP lead on the study, went on to say: “It was done on the practice site because we wanted it to have a therapeutic environment. It wasn’t about trying to get men to engage in sports clubs or pubs or anything like that. Part of our design was to make sure they could have counselling at a suitable time, such as Saturday mornings and evenings.”  
The service was structured so that the GP was the first point of contact for patients and the GP would then refer to counselling or acupuncture, sometimes even both. The process was first and foremost “a safety mechanism because you [may see patients] that are suicidal”.
Ten GPs work across both Victoria Medical Centre and its sister practice Lees Medical Place, Mayfair, London.
The GPs’ roles in such a service can’t be overlooked. “It’s terribly important that GPs actually recommend it to patients. You can have extra services but many patients don’t quite understand what’s going on,” says Rankine. All members of staff, however, played their part. “If receptionists thought that somebody, or they heard on the grapevine [of someone needing help] they would suggest: ‘why don’t you see your GP and ask if you can join this [Atlas].’ Receptionists pick up on these things.”
Given that the target group is notorious for not coming forth with mental health issues, the practice devised interesting marketing solutions to draw the patients in.
Aziz Pandor, practice business operations manager, explains: “Posters went up in the toilets, even the ladies toilets with slogans: ‘Worried about your man? Why not mention this service to him, pick up a leaflet on our desk.’
“Twitter was also used to promote the service and we also publicised
it by putting it into the newsletter,” he adds.
Suicide is the leading cause of death in England and Wales for men aged between 20 and 34 years of age (26% of all deaths in 2012) according to The Office For National Statistics’ Statistical Bulletin: Suicides in the United Kingdom, 2012 Registrations. The document also revealed the highest suicide rate was among men aged 40 to 44 at 25.9 deaths per 100,000 population.
The statistics are worrying –  but not necessarily shocking – as more and more mental health issues are being discussed in the public domain. BBC3 made a documentary with rapper Professor Green called, Professor Green: suicide and me about his battle with depression. The programme approached Victoria Medical Practice about taking part, but due to the fact that the study ended it was felt it wasn’t appropriate. The buzz surrounding this study earned itself TV attention and was shortlisted for the British Medical Journal (BMJ) awards. So what did the study discover that warranted such high praise?
The results were good. Of the 142 men that were referred to Atlas, 78% felt their health had improved.
A team from The University of Westminster carried out the research for the study. “We had a nominated admin worker who liaised with the research team so they could have meetings,” says Rankine.
“They [the team from Westminster] dealt with the statistics and worked it all out. We can’t deal with this side of the study; we haven’t got the time or expertise to deal with any of the research materials.”
The study also looked at their day-to-day life. “That’s what the researchers looked at; it was the whole picture. It wasn’t just the cost to the NHS and how much money was saved on prescribing antidepressants. It was also how many days they took off work. But it didn’t take into account the emotional saving of marriages not ending.
“The results were unexpectedly very good. One patient in particular has now gone back to work, he’s working in government and life has gone back to normal.”
Of course a service like this doesn’t come cheap. There is, like with all services, a financial side that can’t be avoided. The practice didn’t receive any money for carrying out the study. The cost of the study was £65,000 that was funded by Nelsons. The budget covered the treatment as well as promotional material and equipment. The course of treatment consisted of 12 sessions, involving counselling or acupuncture and cost £661 per patient.
This aside, “the health economist from the London School of Economics who sat on the advisory board felt that there would be savings in the long term of over £700 [per patient]”. This figure covered savings on GP time, prescriptions and time off work.
Patient feedback went beyond the study’s questionnaire, which was one way the research team determined patients’ happiness. Rankine received several letters thanking the practice for the help they had received.
The service hasn’t just benefitted patients but also the practice’s long-term understanding of mental health issues. “All our doctors became much more aware of what could be done, that’s the legacy this has left. The whole surgery is much more geared up to men’s mental health needs.”
Despite its success the study has come to an end. Victoria Medical Centre is hoping it can be brought back, but it requires funding. “I doubt it will be NHS mental health [that funds it] looking at what an absolute dire state it’s in at the moment.
“Two clinical commissioning groups (CCGs), Central London CCG and West London CCG, are aware of the Atlas study, but I am not sure they have the means to fund such a service. However, I can possibly see something from the third sector like CALM (Campaign Against Living Miserably) [funding it].”
The practice wants the service back and – as always with the NHS – it boils down to money, and given the widely-reported funding shortfall of £22 billion in NHS finances for such initiatives, the money just isn’t there. Nonetheless what the patients and staff experienced has been invaluable and Atlas has showcased how important it is to look at mental health issues in the NHS. By doing so it has a knock on effect that reduces the burden on society as a whole. People are able to work and there is a reduction on spending within the NHS: there are fewer prescriptions and GPs’ time increases.
Rankine says: “It just shows you what can be done given a bit of innovation and money behind it.”