Mental Health Diagnosis and Support: Dr. Will Robertson on Jorvik Radio

Nick Love
Let’s talk health and mental health, because a recent national survey of GPs in England revealed that over 50% of Doctors said that some stress conditions were being over diagnosed as mental illness. However, those GPs also said that people with genuine, severe mental health conditions often cannot access good quality support. So it’s a bit of a dichotomy, really, because what they do is they have both over medicalisation and under treatment at once. But given it’s the Christmas period when over 30% of the UK population say their mental health nosedives, with additional anxiousness, tiredness and irritation and worry, this seems a good time as ever to discuss mental health in general and what to do at Christmas to approach or address these heightened emotions. And no better person to do it with than Dr. Will Robertson, who works in the NHS and is Clinical Director at Stonegate Medical Clinic. Good morning to you, Dr. Will and a happy Christmas

Dr. Will Robertson
Morning, Nick and Merry Christmas to you and all your listeners too.

Nick Love
So was that survey a shock to you? When doctors say life being stressful is not an illness, sometimes, what do they mean in practical terms? How do you interpret that?

Dr. Will Robertson
I think it was a little bit of clumsy statement, a bit of a clumsy article. It’s also off the back of Wes Streeting’s comments relatively recently, where he was saying very much a similar thing. He apologised for the comments. But it does appear that, heading into winter pressures, there has been a conversation from several high politicians and high groups of GPs, not marginalising mental health but but putting it probably in the wrong, wrong lens. So I think what they were trying to say is that true, depression, anxiety, other mental health have a diagnostic criteria. You have to fulfil certain things. And sometimes we get people presenting to primary care, that have have not met that. And sometimes we do have people that come that have met their criteria, but because of the backlogs in the system, because of the huge amount of unease we have within mental health in this country at this moment in time, people that need the most help can’t get access to it. So I think it would have been a better way to say mental health is hugely important. It is hugely under diagnosed, it is massively under resourced, and it is over stigmatised for people to come forward. However, before you do have a good chat with someone, think about self help. Just try and try and see where you’re at and contextualise everything.

Nick Love
As a GP, though it must be difficult for yourself, because obviously most GPs have these 10 minute segments. How do you distinguish between normal stress and a diagnosable mental health condition in just that 10 minute window?

Dr. Will Robertson
It’s really hard. It’s really, really hard. So again, if we use the medical definition, so let’s say depression, and depression is diagnosed as having three things for a minimum of weeks, and that’s what we call anhedonia, so lack of enjoyment. So things that used to make you happy no longer make you happy, poor functioning. So you can’t do things in life that you used to do, for example, work or get out of bed and get dressed and then having a low mood. So a mood lower than you normally have. So if we were scientific, we would say you need to have those three criteria for at least multiple weeks. But lots of things people might present to you early, and it develops, so it’s very, very, very difficult. And let me give you a contextual example, and this is, I think, what the article is trying to touch on. Let’s say my dog passed away two days ago. It would be entirely reasonable to be really upset about that. Would we call it depression? Probably not. But if my dog died six months ago and I still couldn’t get over it, is that depression probably is. It’s the same cause. So it’s really difficult. It’s really nuanced. And whilst I think the article was trying to say, and Wes Streeting was trying to say, don’t try, try not to overburden a system, unless you feel as a problem, we also must stress. People cannot feel shy about coming forward and talking about their feelings. There must be no stigma on talking about people’s mental health.

Nick Love
That’s a good point, really, because, I mean, if you could wish something that the public could do to better understand stress, resilience and when to seek medical help, what would that be? Because obviously, like anything, we always sense check ourselves, don’t we, and we don’t want to inconvenience GPs when they’re so busy.

Dr. Will Robertson
Hopefully this comes across from our conversation, so within my NHS realm, but also, obviously, Stonegate is a private practice. We have a little bit more capacity there, but it’s never a burden. And again, that’s where I think that the article and Wes were a little bit clumsy. It’s never a burden to speak with our populations. It’s more just about like you say, trying to get people to sense check, but that’s very difficult when you have low mood. So I think really, really, really, what I want our conversation to stress to people is, if you really are confused or you don’t know you’ve got no one to help sense check still come and talk with us anyway. We’ve never had a better time for those kind of things. You’ve got loads of mental health apps. We’ve got lots of good information on the internet. I’ve heard of some studies using things like Siri and AI for conversations with people that are actually improving some of the situations where people are lonely, particularly with elderly and dementia. So I think it’s just one of those things we’re trying, try and get support, try and get a sense check if you can. But again, never, never, never worry about burdening an NHS GP or a GP at Stonegate. That’s the wrong message.

Nick Love
And what changes in services or society then would would help us avoid both, one over medicalising distress, but also dismissing people that really you know, need care. How can we change attitudes? How can we shift the paradigm so that people can be a little bit more objective?

Dr. Will Robertson
We’ve got some good things going on at the moment. We’ve got some bad things. So let’s start with the bad things. I think a lot of the teams Microsoft Teams, culture, Zoom culture, working from home, isolation increasing. We are in a world where, whereas people used to go out every day and see more people, that’s slightly less, there’s definitely more isolation in the world, which is a problem. But then also, we are in a world where people have lots more at their fingertips, like we just touched on this. And you’ve got really good mental health apps. You’ve got people like the Samaritans that you can get on the phone and online. We’ve got some amazing charitable sector work within the NHS. It’s not always got the continuity. And how do we see the same doctor or the doctor you want to see, but access is still there. You can email your practice, can try and get on the phone, walk in in some instances, and again, there are private services like us, and plenty of really good private counselling services that are also getting set up to help deliver care to people when they need it.

Nick Love
Absolutely. And we’re approaching Christmas, and things are heightened there as well. What we’ll do, we’ll take a chat, we’ll come back and we’ll talk specifically about mental health at Christmas.

Nick Love
Love in the Morning on Jorvik Radio. We’re talking mental health with Dr. Will Robertson. He works in the NHS and is a Clinical Director at Stonegate Medical Clinic. Now we’re approaching Christmas, and a recent survey show that over 30% of the UK population, according to Mind, say their mental health nosedives with additional anxiousness, tiredness, irritation and worry. In your experience, Dr. Will, what kind of issues do exacerbate our mental health at Christmas?

Dr. Will Robertson
It’s a brilliant time of year. It’s lots of friends, it’s lots of family, it’s lots of good food. Everyone seems to be happy and but paradoxically, that’s what makes it a very difficult time of year. If you don’t have a really good social support structure, you have to watch everyone else, if you did, and you’re a little bit older, and they’ve all passed away, or a bit too busy again, that can be really tough. And equally, if you’re in the moment, you are trying to support financially, support a family, and you’re aware of their expectations, it can put tremendous pressure on yourself. So I think, you know, I’d say if you if you don’t have anyone, it makes it very hard to watch. If you did, and they’ve gone it makes it very hard to remember. And if you do, but you’re struggling to afford, it makes it very difficult to stomach.

Nick Love
Yeah, there’s this idealised view of Christmas, isn’t there? We see it on the TV. We see it online. The perfect Christmas. You got the snow on the ground, people laughing, sharing. But in reality, it’s very different for everybody, really, isn’t it? None of us, well, usually have a perfect Christmas.

Dr. Will Robertson
Certainly not in the Robertson household.

Nick Love
So again, what are the sort of some of the signs that we can recognise that actually, our mental health has taken a bit of a knock over Christmas?

Dr. Will Robertson
Well, I’d probably split it into our different groups again. So let’s start with a general depression and anxiety. It’s people that have stopped they’ll take themselves away. They’ll withdraw. So people that aren’t communicating as effectively or being a little bit distant, people aren’t enjoying things they used to do, people they can’t seem to laugh or smile as much. Their mood is lower. And people that aren’t functioning. So, you know, if they’re not able to get dressed, if they’re not able to come out and, you know, go to work, or things like that, it’s some real, real red flags. I’d like to make a particular shout out to the elderly, because there’s often huge numbers of elderly people alone at Christmas like we just touched on. And elderly mental health is something that often gets swept under the carpet. I’d also say what’s really important is to look out for your elderly relatives, particularly if they they’re in a home or in sheltered accommodation, or, you know, they’re recently widows, or anything else along those lines. So when we are wrapped up, if we are one of the lucky groups or the lucky people that actually are having the Christmas you described, just make sure we’re looking around, because plenty of people don’t.

Nick Love
Yeah, absolutely that and with regards to ourselves coping with Christmas, then what is some of your top tips? Tell me some of your top advice for how we can help ourselves and navigate through Christmas and our mental health.

Dr. Will Robertson
It’s a great question. And I think it’s what the the article was trying to get to the heart of, and that is not all things in life of butterflies and rainbows. It’s absolutely normal in life to get plenty of knocks. People we love, you know, can get sick, can pass away, we can lose our jobs, we can get bad news. That is part of it, how we how we cope, and how you develop resilience mechanisms, is a part of being an adult. So I think it’s, you know, making sure that you you have a support network. I think it’s making sure that you are looking out for other people as well, that that tends to give us a huge amount of self resilience as well, I think being aware of all the resources out there. So the Samaritans, a lot of people, like meditation, mindfulness, self care. There’s lots of charities involved in, again, promoting self resilience. I know Luke Campbell, the Mayor over in Hull, speaks tremendously strongly about he wants to empower the youth to actually be able to manage some of the knocks that people will inevitably get in life. And then I’d like to finish by stressing, you know, if, if you’ve done self work, if you’ve, you know, reached out to people in your social circle, if you’ve been to the charitable sector and you still feel there is an issue, or people are telling you there’s an issue, please, please, please still reach out to the NHS or us at Stonegate Medical or another private provider. Please, never have a stigma about talking about your feelings.

Nick Love
That’s such a huge thing, isn’t it, communicating, talking about it, and also checking on people and asking twice. So we all ask somebody once how they’re doing and that they’re fine about it, and sometimes, actually, you need to dig a little bit more without being obtrusive, don’t you? Especially if it’s a family member or a good friend. Let’s say.

Dr. Will Robertson
Can I give you a really interesting example?

Nick Love
Yeah

Dr. Will Robertson
One of the reasons I love being a GP and is general practice about is about people. It’s about relationships, about communication. The classic GP is birth and bury. I have three kids. I was picking up my middle child, a two year old boy, from our nursery yesterday, and I was just doing the idle chat, the awkward speaking with other parents. I was talking to one of the Dads. I see him all the time. We don’t really know each other that well, it’s usually that, “Oh, hey, how you doing?” “Aw, tired. How you doing?” Tired, Haha.” And then everyone moves on. You pick up a child and run away. And our kids were a bit delayed coming. So he said, How you doing? I was like, tired. Just had our third child. Work’s been really busy. I’m struggling. I could do with a break. It was amazing. He just melted and go, me too. My I just had my wife’s brother passed away. It’s Christmas. I don’t know how to support her. I’m I’m really struggling too. And we had this bizarre conversation where they said we didn’t know each other from Adam for the next five minutes, we unloaded and just spoke about all the things we’d like to do to make it better. And I left that nursery not only hopefully with a new mate, but feeling a lot better. So just like to say your comment on communication, asking twice and really listening to people is a beautiful, unmedical way to really get to the heat of mental health over Christmas.

Nick Love
And what you did and what he did, you gave each other permission to talk, didn’t you? And it’s that lovely phrase, you know, we got two ears, one mouth. Use them in that proportion as well.

Dr. Will Robertson
I love that.

Nick Love
Yeah, because it is about that, and it is about and you’re very right as well, about supporting others at Christmas. You know, look at look out for people, and look out for people and be kind, give people space, try and understand what they’re going through, because sometimes we can’t, and again, sometimes I look at something and I go, I wish I’d, you know, I wish I’d have been a little bit more accommodating. You don’t have to be cruel sometimes to be, you know, not as understanding as you can be.

Dr. Will Robertson
I completely agree with that, you know, the concept of be kind. I’d also think it’s worthwhile saying, whilst this article was talking about over medicalizing mental health, there’s a couple of myths about mental health that I’d love to challenge as well.

Nick Love
Yeah

Dr. Will Robertson
Seeing people, hopefully listen to our segment on Men’s Health, and one of my big things, as I say, with Men’s Health and with a lot of medicine, seeking help isn’t about weakness, it’s about strength. It’s the same with mental health, seeing a councellor, speaking about feelings, isn’t weakness. Taking mental health medications, if you are appropriate, is not weakness. Most of them aren’t addictive. Most of them have very manageable side effects. If you speak with your GP or a Doctor at Stonegate we’ll listen. We want to remove the stigma with everything, talking about mental health amongst your friends, your family, communicating with normal people, but also, if you are seeing a medical professional, it’s not weak to get counselling. It’s not weak beyond medication and treatment. This is how people get better.

Nick Love
And if people do want to get in touch with you or with Stonegate, what is the best way of doing that?

Dr. Will Robertson
So I think within the NHS, everyone is working so tremendously hard. So with your NHS practice, just get in contact, either E-consult or via the phone, or some practice will allow people to walk. In those contacts will usually be triaged. So don’t be surprised if if you get offered a telephone call or if you get put through to someone called a first contact mental health practitioner, it’s just we have such a volume of work, that’s how we try and organise it. So please do still get in contact with your practice. Stonegate Medical we are a bespoke, small Private Practice. If you call up, they’ll be able to book you in with one of our Doctors, or one of our Counsellors. We have two – usually within the next couple of days.

Nick Love
And you’ve got a website as well so people can look on there and and have a look at what you do, stonegatemedical.co.uk. Well, we wish you the very best of Christmas. Get some rest. Get some sleep, and obviously congratulations on the newborn, and we will speak in the New Year on another important subject.

Nick Love
Absolute pleasure, and Merry Christmas to you too, and everyone at Jorvik Radio.

Nick Love
Thanks for your time.