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.
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.
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.
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.
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.
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.
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.