Experiences of general practitioners in supporting the mental health of children and young people: An exploratory qualitative study in the United Kingdom

Abstract

Mental health (MH) problems in children and young people (CYP) are on the rise, negatively affecting their quality of life. General Practitioners (GPs) are the first port of call for any health-related issue; however, it has not been fully explored what kind of training, tools or management strategies they use for CYP’s MH. The study’s aim was to explore and report experiences, challenges and strategies that GPs in the UK have to address the MH needs of CYP. Ten semi-structured interviews were conducted with GPs. Qualitative content analysis was used resulting in two themes and five subthemes. Most GPs reported receiving experiential training to address MH issues on CYP and explained some of the most common presentations and whether these are primary or secondary causes for consultation. In the second theme ‘Management Approaches’, GPs draw on different barriers to communicating with CYP and their families or other relevant parties (school for instance), but they also discuss treatment approaches including pharmaceutical. Participants shared myriad tools, resources and strategies they have used to address CYP’s MH. Although GPs provided valuable insights on this topic, the study shows an urgent need for providing systematic training and management strategies to respond to MH problems appropriately.

Introduction

Identifying and treating mental health (MH) problems in children and young people (CYP) is a global challenge (Kessler et al., 2009; Patel et al., 2007). It is reported that one in 10 CYP (aged 5–16 years) has a diagnosable MH disorder (Green et al., 2005) and this has increased (England – RCPCH – State of Child Health, nd) before the pandemic. Alongside the often devastating effects on young people, MH problems also have significant broader detrimental impacts, such as reduced education attainment and quality of life (Jokela et al., 2009; Knapp et al., 2011) alongside substantial associated economic costs (Snell et al., 2013).

Despite the importance of CYP receiving early identification and effective support for MH problems, in the United Kingdom (UK) to prevent crisis or suicide (England – RCPCH – State of Child Health, nd) many staff in CYP’s MH services find it challenging to implement support in line with established guidelines and care pathways (Hinrichs et al., 2012). It is well established that many MH problems are initially diagnosed in childhood (Kim-Cohen et al., 2003) and most are managed outside of specialist MH services. For instance, General Practitioners (GPs) typically play a key role in recognising and managing CYP’s MH problems in the UK (Snell et al., 2013). This is perhaps unsurprising considering that children tend to present to their GP at least once a year (Hippisley-Cox and Vinogradova, 2009), and they are typically the first port of call for parents who are concerned about their child’s MH (Jorm et al., 2007; Kramer and Garralda, 2000; Miller, 2007). Perhaps due to a potential ongoing and trusting relationship (Hinrichs et al., 2012) CYP often express MH issues to their GP (Roberts et al., 2013). Despite this, GPs often prioritise physical health (O’Brien et al., 2016) or in some instances can identify severe MH issues but may miss less severe MH presentations (Kramer and Garralda, 2000; Perkins et al., 2010).

Given the sheer scale of MH issues within CYP in the UK, it is essential to increase availability of support within primary care (Kramer and Garralda, 2000); in this case, it is vital that GPs are knowledgeable, confident, and skilled to identify and manage the vast and complex MH needs of CYP (England – RCPCH – State of Child Health, nd). A systematic review identified many barriers for GPs to effectively manage and support CYP with MH problems, including lacking confidence, knowledge and skills to do so (O’Brien et al., 2016). Such deficits need to be addressed through training, and this should be considered a high priority (Hinrichs et al., 2012). From a perspective of primary care health services, it has been reported that there is often little to offer in terms of MH services for CYP (Fuller et al., 2011). However, factors determining referral to specialised MH services are unclear (Kramer and Garralda, 2000). There may be other external factors that influence how GPs manage MH issues in CYP. Some studies have shown that referrals can often be rejected, and therefore, primary care health professionals need to accommodate this (Kramer and Garralda, 2000). Research on how much and to what extent GPs' knowledge and training can support CYPs’ MH needs is warranted to understand what interventions should be developed to support them in this aspect of their practice.

Aims

- To identify the experiences, challenges, management approaches and recommendations in identifying and managing CYP’s MH issues of a selection of UK-based GPs.

Methods

Design

This is a qualitative study, using semi-structured 1-1 interviews.

Population, recruitment and setting

This study was conducted at a single NHS trust within the Midlands area of the UK.

Eligibility (inclusion) criteria were as follows: (1) currently working as GP within the specified NHS Trust; (2) experience of identifying and managing MH issues in CYP. Exclusion criteria: GPs outside the specified Trust, unqualified and/or without experience working with CYP.

A convenient sample was used with support from key gatekeepers within the NHS Trust. Potential participants were then sent an email with the study information and contact details. 15 GPs approached our team; however given time constraints, only the first 10 GPs were included.

Data collection

The interview guide was piloted beforehand with two practicing health professionals and edited according to their feedback.

Data analysis

Interviews were video and audio recorded to facilitate verbatim transcription, thus video was used when audio was not understandable, seeking in this way to increase trustworthiness. Pseudonyms were used and data was analysed using the qualitative content analysis approach following eight steps suggested by Zhang and Wildemuth (Wildemuth, 2016). This approach involves preparing data, coding texts and then making inferences from data meanings. This allowed to observe trends in respondents’ opinions that can be categorised into themes. NVivo 12 by QSR international was used to store and aid in coding and grouping of themes and subthemes. Only one researcher coded the data. Since interviews were semi-structured, the interview guide also helped organise and code data, but the main themes were derived from data. No field notes were required. To increase trustworthiness, data analysis was an iterative process, and reflexivity after each interview supported and enhanced the interview guide, especially to add follow up questions as well as probes and prompts if participants went on a tangent. Peer debriefing with other team members was also used to produce relevant discussions around this topic (Lietz et al., 2006). Transcripts were only shared with the research team. Quotations from participants are presented throughout using pseudonyms.

Ethical considerations

The study received ethical approval from the Ethics and Research Committee of the School of Health Sciences at the University of Nottingham, number FMHS-99-0920.

Findings

Ten semi-structured online interviews (between 28 and 35 min) with an average duration of 32 min were conducted by the lead author between December 2020 and March 2021. GPs who took part (six women and four men) were mostly of white British origin and reported a wide variety of experience as GPs. The first round of coding was composed of 12 themes and a total of 24 subthemes. Re-coding and grouping continued until most salient themes from all interviews were generated. Final thematic analysis resulted in two themes and five subthemes, which are presented below. We draw on some discussions for diverse cases across thematic description.

‘Familiarity makes it easy for us to diagnose it better’ – Recognition

Training, knowledge and skills

Eight GPs reported not having formal training in MH for CYP specifically, whereas two GPs reported having attended clinics during their GP training, but most rotations were in adult psychiatry, resulting in limited exposure to CYP’s MH issues during training. After graduation however, GPs outlined attending monthly seminars or having protected learning time (PLT) where they improve skills and knowledge; however, this appears limited with regard CYP’s MH. Overall, GPS reported learning as they get exposed to cases at work

‘[…] kind of informal training. A lot of it is kind of experiential […]’ Tanner

Type and frequency of presentations (profile)

Two GPs expressed common backgrounds of many of CYP presenting with MH issues, one reported CYP from deprived areas and multi-ethnic CYP, and another reported students undertaking courses to enter university (16–17 yo). Almost all GPs reported encountering CYP with MH problems weekly and two reported identifying these issues two to three times per day. An out-of-hours GP reported that although MH issues in this population are not frequent within their out of hours service, if and when they present, presentations fall into a more serious or risky category.

GPs reported that the most common presentations included self-harming, depression, and anxiety. In addition, more than half of GPs reported that MH issues are often primary reason for consultation, having already been identified by CYP, rather than GPs identifying this as a secondary issue.

‘[…] these are very self-conscious groups so even if it is confidential a lot of it is what their own health experiences have been in their own life what maybe they have seen mental illnesses in their family and friends and these influences can affect how they interact […]’. Nate

Furthermore, seven GPs reported that parents were expressing concerns when they noted changes in children interacting with others, or in their behaviours at school, etc. In this case or also when a physical issue is expressed primarily, GPs needed to build more rapport with children using their communication skills. In some cases that means GPs ask parents to leave the room or/and GPs to avoid driving an agenda where CYP would not feel comfortable.

‘[…] it can be that they are coming because of their spots and then they happen to mention that they are being bullied, they are sad or mad or not eating properly and so you have a very complicated consultation, often with a dynamic with the parents as well’. Rangan

‘[…]how you feel about not being at school or how do you feel about COVID and the situation […] and that’s when it starts to come out slowly, slowly’. Irina

At least half of the GPs expressed how the Coronavirus disease 2019 (COVID-19) pandemic influenced the prevalence of CYP presenting with MH issues with anxiety, self-harm and isolation being widely mentioned.

Complexity of recognition (differential diagnosis and tools)

GPs reported a range of questions and strategies to obtain more information about the MH issues in CYP. GPs attempted several strategies to build rapport and communication, including talking to patients directly instead of typing; active listening; normalising low or sad feelings; being flexible; trying to understand them by having an open conversation; leaving their door open; being empathetic; asking open-ended questions; and avoiding judging language or body posture.

Several GPs identified differences between pre and post pandemic in terms of how they identified problems and type of MH presentation. A reported disadvantage was lack of observation of body language. Presentations derived from the pandemic were more related to self-harming, low mood, anxiety, and obsessive-compulsive disorder, with an indication of a higher frequency of MH problems among CYP.

‘[…] I have had quite a lot of patients that they are picking at their skin harming themselves in that way […]’. Elizabeth

There was no consistent use of tools or questionnaires for differential diagnosis, but GPs tended to report using verbal questioning to explore indicators and severity of MH issues, that is, mood changes, triggers, coping mechanisms, risk assessment, and body language.

‘Say people have got self-harm marks on their arms, or even healed scars – as a doctor you’re in a unique position to say “what’s that?”’ Tanner

Most GPs reported that it was a judgement call to decide how quickly CYP needed intervention, according to symptoms and how CYP were functioning. Based on this, GPs decided how to manage these issues with CYP or whether signposting or referral was warranted.

‘They need to be able to trust us’ – Management approaches

Communication, rapport, and family and cultural barriers

When the presenting MH issue does not warrant immediate intervention, GPs follow up with additional consultation, offering self-help resources, or, in some, although rare, offering pharmacological intervention, typically with support of senior colleagues. Two GPs reported using NICE guidelines to make decisions. In some instances, GPs report gathering background information from wider sources such as school and family members.

‘Working out what the management plan it’s going to be […] what are you going to do, who is your person that you are going to go and talk to. […] It’s always mapping out what are they going to do if things get bad’. Elizabeth

GPs described a variety of approaches and skills to support and manage MH issues in CYP. These included active listening, repeated consultations, purposeful relationship building, investigation with examples to help CYP expand, brief, time-limited psychological interventions, and solution-focused approaches.

‘We sit down, we make a plan, I do a bit of explaining about what’s happening and also what to expect, and most of the time it is a matter of either a follow-up involving the teachers, sometimes giving them the online resources […] make sure everything is fine and we didn’t miss anything’. Dante

More than half of the GPs expressed opinions on perceived unhelpful approaches to mental health in CYP. For example, four GPs reported that psychotropic medications were not a long-term solution, in part due to a possible perception of conflict of interest from GPs and side effects that may not be well known partly because GPs are not trained to monitor this and partly due to the public’s misconceptions about ‘easy fix’ medications. Despite some hesitancy from some GPs, there was a clear variance in opinion, with some reporting great potential benefit of psychotropic or supplementary medication

‘[…] if the patient is onboard, the family is on board and why do we have to wait because of this specialised rule that treatment to be initiated, why you delay a potentially lifesaving treatment, but some of my colleagues are so scared of getting this wrong[…]. Melatonin is a great example and its widely used and it’s a very safe drug. It’s a sleep hormone, we use it a lot we use it with ADHD, […] a bit expensive and unfortunately because of funding and rationing people say we are not allowed to use it that can only be used by a psychiatry. […] it can save families from having a major breakdown, it can save children with really difficult behaviour getting a couple of hours sleep or four hours instead of two’. Rangan

Eight GPs who had preference for nonpharmaceutical treatment mentioned counselling as an option and said they do not provide it but rather signpost to it. Nine GPs also reported feeling uncomfortable, inexperienced and unprepared to prescribe medication to teenagers (particularly younger than 17). Other GPs expressed that this could often be viewed by patients as a desperate solution.

Phone triaging seems to interfere with getting the whole story from parents or children. In terms of communicating amongst colleagues, practice managers and administrative staff, a couple of GPs suggested a consistent system whereby GPs can be made aware of resources available for a range of presentations.

Nine out of ten GPs explained how to get around these challenges. Since children are tech-savvy, they can access more self-help tools and navigate through various options. These preferably need to be tailored for children to access by themselves. Ethnic diversity was reported as a factor for which more flexibility was needed from GPs. Teachers and school staff were reported as ports of call when it comes to teaching how to recognise MH issues and create an environment to talk comfortably and confidentially about them. This was highlighted as a key need in the most deprived areas but also amidst the pandemic, which saw an increase in MH issues in CYP. Additionally, teaching medical students about how to address CYP’s MH was reported to be vital and to be demonstrated as a conversation rather than a robotic process with a heavy focus on using screening tools only.

Treatment, resources, and skills for further support

GPs reported general management tactics that included offering general recommendations and then follow-up, encouraging young people to think about someone to whom they can talk to in school or similar settings, giving patients more time during a phone consultation, prioritising children, engaging families and prompting participation of patients at the same time.

Half of GPs recognised sources where they could get some input to decide on pharmaceutical treatment, whether this was a psychiatry hotline, discussions with colleagues, psychiatry service (for specific conditions such as Attention Deficit Hyperactivity Disorder, obsessive compulsive disorder) or having the backup of a private psychiatrist should parents decided to go down that route. Additionally, GPs suggested including specific topics to address CYP’s MH during weekly seminars or protected learning time, tying these preferably to local services. Finally, all GPs reported signposting CYP and their parents to a variety of resources, namely, online counselling, online psychoeducation, telephone MH support lines, and third-sector organisations or voluntary organisations.

All GPs perceived current MH services for children and young people to be saturated and underfunded, resulting in long waiting lists (months or years). These seem to affect the family’s dynamic.

‘It’s not acceptable to say ‘oh, you’ve got a child with low mood? I’ll see you in nine months. A lot can happen in nine months’. Tanner

‘[…], they’re going through such a difficult time’. Dante

GPs reported that they would refer to other services, for instance, to the school when there is a counsellor. Some reported that parents would also choose to go through the private route.

At least half of the GPs reported they would only get feedback if they followed up CYP and they noted positive changes. Only a couple of GPs have the habit of asking at the end of a phone call or consultation if that was helpful.

‘[…]you see that they are actually improving […]you seem to have been making progress. I have had parents on the phone very grateful particularly the ones where I got urgent CAMHS intervention […] to say thank you so much we are so happy we got the support in place now is making a difference’. Irina

Discussion

We were able to obtain and outline the experiences, challenges and approaches in identifying and managing CYP’s MH issues from a UK-based sample of GPs. GPs reported experiential (on the job) knowledge on CYP’s MH, rather than receiving formal training. MH issues have been increasingly frequent, and GPs reported specific strategies to probe this from CYP and their parents. Deciding about management seems to depend on whether issues warrant an immediate intervention or not. For the latter, GPs seek to involve family, school and endeavour to provide non-pharmaceutical treatment and follow up appointments.

Almost a tenth of children worldwide and 14% of young people have a mental health disorder and are the leading cause of years lived with disability (World Health Organization, 2022) is a growing proportion of referrals to MH services across the NHS (Gilhooly and Clarke, 2021). GPs acknowledged that for those in urgent need of intervention waiting times for referral were long and taxing, especially for families. Almost all GPs reported serious concerns about medicating CYP for MH problems and rather discussed a myriad of resources to signpost CYP for a range of MH presentations. In this way this work has presented some recommendations that are currently used by GPs in order to identify and manage MH challenges in CYP.

GPs reported a lack of training in MH for CYP during their medical education, which has been reported before (Roberts et al., 2013, 2014) and only a few gained experience due to their rotations when training as GPs. Although most GPs encountered CYP with MH issues at least weekly, this appears variable across practices and locations (Hinrichs et al., 2012). However, it was reported that the majority avoided bringing up MH issues if CYP did not report them as the primary cause of consultation (Hinrichs et al., 2012). Building a trusting and therapeutic relationship indeed appears to be one factor that increases chances of young people disclosing MH difficulties (Mauerhofer et al., 2009). It is worth mentioning that this study was conducted during the series of COVID-19 lockdowns, and therefore, some participants linked some of the frequency and presentations with this, whilst others reported a difference pre- and post-pandemic. This is helpful in understanding the post-pandemic world, where many GP consultations happen over the phone (Priestman, 2020). In addition, reports on how MH was worse at the beginning of the pandemic and how it is likely to have greater strain on MH services given the likely increased demand (Gilhooly and Clarke, 2021).

GPs who had more training or experience in MH reported that many presentations are ‘low-level’ MH and, in this sense, they would not refer to secondary care but rather guide self-help resources. This may not be the case in other studies (Hinrichs et al., 2012) and with young autistic spectrum disorder (ASD) populations, who seem to visit GPs when their MH difficulties become acute (Coleman-Fountain et al., 2020).

Although various studies have reported that general practitioners experienced limitations in their ability to recognise severe MH issues (Roberts et al., 2013), and do not feel confident in identifying and diagnosing particular stages of MH issues (O’Brien et al., 2016), our data suggest that they look for red flags, for example, self-harm or Attention Deficit Hyperactivity Disorder, symptoms, similar to that which Hinrich et al. (2012) reported as long as MH symptoms are the primary cause for consultation. When brief training on MH has been provided to Australian GPs, they have improved their ability to deliver early intervention (Luk et al., 2002). GPs in this study, though, recognised that they lacked both medical school training as well as specific criteria to guide their consultation with CYP; therefore, they use their clinical judgement.

Despite some GPs reporting that they tried to follow up with patients, systemic constraints prevented them from pre-booking appointments, and in addition, pandemic restrictions limited their ability to assess non-verbal cues from CYP and impacted their ability to build rapport. Inflexibility of healthcare systems to address these presentations has been reported before, even without pandemic conditions (Roberts et al., 2013).

GPs signpost patients to a range of resources; however, despite the sample consisting of GPs from one geographical area, there was substantial variance in which resources were suggested, demonstrating a lack of consistency and communication across systems to cascade relevant resources to all GPs so that they can recommend them widely. There seems to be a culture of letting GPs get hold of their resources according to their interests or seminars they attend during their PLT. This can lead to increased anxiety in physicians when faced with MH issues in this population (Roberts et al., 2013). Indeed people with ASD have reported that primary care does not normally meet their healthcare needs (Coleman-Fountain et al., 2020). More on-the-job training and structured continuing education programmes that include MH have been asked for by another cohort of GPs, particularly in rural areas of Australia (Aoun, 1997). This same author reported that time for consultations was an important barrier to properly assessing and deciding treatment plans for CYP with MH problems (Aoun, 1997).

GPs expressed some confidence in building a successful relationship with young people. For example, some attempted to have conversations rather than just asking questions, others intended to normalise MH difficulties, others observed body language and offered follow-up appointments to continue discussing what patients wanted. It may be of interest to understand whether patients’ sex and age influence how doctors build relationships. It appears that young people are more likely to discuss MH issues when they frequently attend their GP (Mauerhofer et al., 2009). This may improve relationship building to express MH difficulties. Furthermore, by using communication skills, GPs facilitate managing and understanding health issues (Coleman-Fountain et al., 2020) and effectively communicate with CYP (Lempp et al., 2016). These skills, however, are lacking in GPs for MH, at least in Australia (Alexander and Fraser, 2008).

Some GPs said that young people were often unable to express their emotions or MH difficulties. IN contrast, other GPs stated that the current generation of CYP appears more aware and more able to express difficulties. Previous research has reported that GPs often experience professional anxiety when facing volatile and unpredictable situations such as adolescent behaviour with CYP (Roberts et al., 2013) and that they find it difficult to manage them (Aoun, 1997; Roberts et al., 2014). In addition, social environment is typically highly relevant to understanding the young person’s presentation (Aoun, 1997) and most GPs in our study also recognised that is essential to understand this wider context before making decisions. This may include, but is not limited to, issues at school or with family and friends. Furthermore, CYP’s family can facilitate young people to express their MH difficulties (Coleman-Fountain et al., 2020).

In our study, most GPs reported a lack of confidence in prescribing medications, and many asked for more systemic support to be available. One reported an example of a safeguarding line to resolve a query in 24 hours and provide guidance. This is similar to other reports that Australian GPs were somehow not unconfident in prescribing medication to children (Alexander and Fraser, 2008) and only a minority would offer other short interventions such as CBT (Hinrichs et al., 2012). GPs of other studies seem to be interested in acquiring basic psychotherapeutic skills (Lempp et al., 2016).

There is a lack of options to refer patients other than CAMHS. Saturation of services can lead to a wait of up to 10 months (England and Mughal, 2019); however, GPs expressed that this has worsened with the pandemic. Some reported having seen more CYP with MH difficulties and a couple said that specialist services such as CAMHS did not respond adequately to the pandemic. A lack of understanding of referral pathways and CAMHS roles may be unclear to GPs (Roberts et al., 2013). On one hand, GPs should not be expected to make a diagnosis before sending to CAMHS but on the other hand, even for diagnosis purposes, patients would have long waiting times (Aoun, 1997; Gilhooly and Clarke, 2021; Hinrichs et al., 2012) and most GPs considered this was not acceptable. In addition, Hinrichs and cols (Hinrichs et al., 2012) found that referrals from GPs to CAMHS are more likely to be rejected than if coming from other sources (e.g. A&E or local authorities).

GPs in other studies have reported having limited contact with secondary care colleagues to receive more support for these patients (Roberts et al., 2014). Some GPs in this study reported that this is often due to a lack of information in the referral letter and that CAMHS often reply with useful sources where patients can be signposted by GPs, which has been documented before (Aoun, 1997; Hinrichs et al., 2012). Explaining referral processes and changes to parents seems to be a taxing responsibility for GPs, which is similar to reports stating that they do not wish to raise more expectations among family members (Roberts et al., 2014). Parents/carers often take the private route or are aware of long waiting times beforehand, and lastly may have a negative view of the referral system, for instance, for eating disorders, when a parent could not understand why their daughter needed to lose more weight to get a referral accepted.

Limitations

This study’s findings lack transferability since it involved GPs working in one geographic location within England and, as such, may not be reflective of wider experiences of GPs across the NHS or other countries. Another limitation is that the interview guide supported data analysis and organisation, thus allowing the focus on major themes only. Additionally, due to resource constraints and competing responsibilities on the research team across the pandemic scenario, only one researcher could perform data analysis.

Strengths

Using semi structured individual interviews allowed to obtain a breadth of views with details that show transparency and robustness to this research. The interviewer’s debrief sessions and own professional background helped prevent biases and the lead author’s own views from interfering with data interpretation.

MH in children and young adults is an increasingly prevalent topic and GPs seem to be key gatekeepers; therefore, gaining insights on this topic is valuable to help delineate strategies to improve how MH is dealt with across these populations.

Implications to research/practice

Findings demonstrate that GPs experience a dearth of support and services for CYP’s MH, namely due to lack of specific training and limited screening tools available for this population. This was shown to be lacking during GP training, but PLT seems to be a viable way of obtaining this knowledge. In Australia PLT or CPD should also be linked to local resources to be relevant for GPs (Aoun, 1997). The need for user friendly evidence based resources to tackle self-harm, for instance, has been highlighted before (Townsend et al., 2023). Other suggested topics from these authors were myth-busting, risk factors for self-harm in young people, raising the issue, and using the right language. A couple of questions to CYP if GPs suspect MH issues, may make a difference in improving primary care services (Rutman et al., 2008). This paper can add to the Grand Challenges research for mental health promoted by the World Health Organisation (2022) which can be translated into practice around the globe.

Clinical commissioning groups were assigned funding to train medical staff to improve the provision of MH services in primary care as well as to promote a whole systems approach (NHS, voluntary sector, local authority and education sectors) focused on the needs of CYP with MH issues (England and Mughal, 2019). Monthly multidisciplinary meetings have been suggested to foster child and family-focused knowledge (Hinrichs et al., 2012). Open communication between GPs and schools should be enabled by CCGs to ensure young people are appropriately managed and followed up (England and Mughal, 2019).

It is essential for GPs to gain clarity on where to obtain more resources to signpost to and understand specific referral pathways across the board. It is also important to develop, as in adult MH care, ‘watchful waiting’ to help early detection of MH issues and increase availability of systemic resources, as well as links to social services. Every practitioner in primary care should be ‘armed’ with a set of tools, resources and knowledge to address CYP’s MH (Hinrichs et al., 2012). However, taking the lead in the introduction of MH primary care services may allow GPs to identify patients quicker and relieve pressure from CAMHS (O’Brien et al., 2016).

Conclusion

This study obtained valuable insights from GPs who frequently identify and manage MH issues in CYP. Due to increasing struggles from CYP in this area, the research can add a novel perspective on why it is important to prioritise this population in the UK’s health agenda. We documented how GPs’ experiences in identifying and managing MH issues in young populations appear to be typified by a sense of feeling unequipped, untrained and under resourced to effectively address and manage them. Despite this, GPs report several ways of navigating these deficits in an attempt to provide safe and effective support.

The study shows a clear and urgent need to train GPs in how to identify, diagnose and manage MH issues in CYP. This research, however, found valuable information for other UK-based GPs to tackle a lack of systemic training and guidelines for CYP’s MH.