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Auberon

Brief Outline: Auberon has had problems with anxiety and depression, and sometimes self-harmed. The doctor he preferred to see was very supportive, tried to ‘go the extra mile’, and booked him in for double appointments.
Background: Auberon is a student and lives at home with his parents. Ethnic background / nationality: White British.

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As a child, Auberon used to see the GP (local doctor) for minor issues such as coughs, colds and ear infections. More recently, he had seen the doctor because he had anxiety and depression and sometimes self-harmed. 

When Auberon was younger, his mum used to take him to the doctor. Once he turned 16, he made and attended appointments himself. Auberon’s local surgery opened 7 days a week, 8am to 9pm, and also operated as a walk-in centre. These convenient opening times meant that he could have appointments over the weekend without missing college. The surgery also had an online booking system which he found ‘very useful’, particularly for ordering repeat prescriptions.

Auberon was on an ‘enhanced care plan’, which meant that he was usually seen by a GP within a day. The longest he’d had to wait was three days. Auberon often needed to see a GP or nurse urgently for a dressing change. He was usually seen quite quickly and, when he couldn’t get a same-day appointment, he went in as a walk-in patient though this meant having to ‘wait a while’. He was also under the care of a psychiatrist. 

On one occasion when Auberon self-harmed ‘quite badly’, he couldn’t attend any of the appointments he was offered with a GP or nurse, and the waiting time for the walk-in centre was ‘ridiculously long’. He ended up going to A&E (Accident and Emergency) instead. He would like his local surgery to employ more staff so he wouldn’t have to go to A&E when he can’t be seen by a GP. 

Auberon had had a ‘pick n mix’ experience with GPs – he found that some were better than others. Some were ‘really lovely’ while others had little understanding of mental health and thought ‘it’s all a big joke’. Although Auberon tried to see a GP who was understanding, the doctor he got depended on who was available on the day. The doctor he normally saw was very supportive and tried to ‘go the extra mile’. Although appointments were usually only ten minutes long, this GP always booked double appointments so Auberon had enough time to talk. 

Auberon’s experiences with receptionists, nurses and pharmacists had been very positive. Receptionists at his local surgery knew him by name and were friendly. Pharmacy staff had also been ‘really good’ – whenever he needed to speak to someone about his medications, they were ‘always happy’ to talk to him in a private consultation room.

Although Auberon felt that many GPs were ‘very good at talking to young people,’ he would like them to have more training and understanding of mental health and to take self-harm seriously. He felt that many young people had ‘no one to talk to’ and needed to be made aware of the mental health services available to them.
 

The staff are good at Auberon’s chemist. He can talk in a private consultation room about his medications, especially if they’re new tablets.

The staff are good at Auberon’s chemist. He can talk in a private consultation room about his medications, especially if they’re new tablets.

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And in terms of the health centre, is there a pharmacy near there as well then? When you’ve got your prescription, you can easily get them?

There is in the supermarket near, right next door to it, yes.

So easy walking distance?

Yeah, about two minutes' walk.

And how have you found the pharmacist and the staff at the pharmacy?

The pharmacy staff have been really good actually. If they need to talk to me about my meds, they always take me to a consultation room where it's private and stuff, so yeah.

So that’s very good; it's all confidential…

Mm it's all confidential. I don’t feel like I'm talking in front of a whole supermarket, and all the queue behind me. I just feel like… if I personally want to talk to a pharmacist I can just say to a member of staff, "Is it possible for me to talk to the pharmacist in the consultation room?" I might need to wait about five minutes till they finish what they're doing, but they're always happy to go to talk to me.

So do you often suggest it yourself or do they suggest it?

They, in terms of if it's either mentoring for new meds or something, then they would talk to… then they would suggest it, but I never suggest it, no.

So they suggest it themselves and that’s been helpful?

Yeah.

Have you felt that you can talk for as long as you want and not feel rushed or…?

Yes.

So do you see the same few pharmacists there every time or is there a different...

It's all… most of them work there Monday to… the same ones I think work there Monday to Friday, but I think I've seen different ones at weekends.
 

Auberon often gets his medication from the supermarket pharmacy. The waiting time can sometimes be long but it’s open until 8pm.

Auberon often gets his medication from the supermarket pharmacy. The waiting time can sometimes be long but it’s open until 8pm.

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And you mentioned this is a pharmacy in the supermarket?

Yes.

Do you prefer that it's in the supermarket, or would you have preferred a pharmacy that’s just like separate pharmacy, like a Lloyds Chemist or something like that?

I don’t think it makes much difference to me apart from the fact, if it's a Lloyds Chemist, or if it's inside a Tesco, which this one is, I think that not like separate pharmacies to supermarkets like Lloyds have less waiting times. So, they're like , "Come back in five/ten minutes, your prescription will be ready", whilst in supermarkets I've been waiting about half hour because they had a lot to do. They have a lot of patients there because it's more of wide…because it's a bigger…it's in a supermarket so lots more people go and get their prescriptions there. 

So, then they're like, "Come back in half hour; do some shopping… do some shopping if you wanted to, and then come back to collect your prescription." I think it doesn’t really make much difference.

So it’s more how close it is to the GP's surgery?

Yes.

And how easy it is to get there?

Yes.

And these ones in the supermarkets, are they open till quite late now?

They're open till 8.00pm  

8.00pm.

So nine till eight, so yeah.

So often would you say you have to wait for around half an hour?

Around half hour, could be less really, depends on how much customers they have really.

And in that time do you walk around?

I walk around, do some shopping, yeah.

And in terms of the role of pharmacists, is there anything that you think could be improved there, or do you think it's fine as it is, what do you think?

I think it's fine as it is really. There could be more pharmacists working on a particular shift, but to see more customers very quickly especially in supermarkets. But I think they're good, so yeah, they do a good job.
 

Auberon, who’d self-harmed in the past, had seen the nurse a few times for cuts and dressing changes. The nurse was really good and he didn’t feel rushed.

Auberon, who’d self-harmed in the past, had seen the nurse a few times for cuts and dressing changes. The nurse was really good and he didn’t feel rushed.

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Have there been any situations where you’ve been able to see the nurse instead of the GP?

Only for cuts and stuff, and for dressing changes but not really, no.

How have the nurses been?

The nurses have been good, really good, yeah.

So really good.  Were they understanding?

They were understanding and, yeah, and if you needed they would ask me to see a GP and stuff, yeah.

So did you have a proper time with the nurse, or did you feel all rushed at all or?

I had a proper time with the nurse, because nurse's appointments aren’t time limited, so they're not ten minutes. They're as long as you need really, so which was good.
 

Young people often feel that there is no one to talk to about mental health. Auberon felt like that too. People should get help from their GP before it gets serious.

Young people often feel that there is no one to talk to about mental health. Auberon felt like that too. People should get help from their GP before it gets serious.

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If young people are feeling anxious or depressed, do you think they know that they can go to see the GP?  Do a lot of the young people know that you can see the GP for…?

I don’t think they do. And I think that message needs to be getting out there in terms of mental health because I felt like this before. I knew my GP was available, but there was no-one I could talk to. And I feel like that’s how young people are feeling; that there's no-one that they can talk to, and I think the message needs to get out there that young people can go and see their GP and their GP is there to help them.

Yeah, so they can… apart from physical problems, they can see their GP about mental health issues, emotional problems?

Yeah.

So, even to the extent, I think you had a leaflet or something; I don’t think I've got it here now. For example, other problems that they might be having, to do with bullying or stress with exams, or anything like that, should it be made available this sort of information; all the different reasons that you can see the GP?

Yes, because I think bullying… because bullying can lead into mental health, and also physical health, illnesses, and so can stress with exams and stuff.  I think they need to see their GP before they get into a mental… before it starts to need to… under the mental health road. And so it just can break it off there and they can sort it out there before it starts to get more serious.
 

Auberon had been having counselling and later spent a month in hospital. He had to wait 2 years for therapy when he moved to adult services but feels it’ll help.

Auberon had been having counselling and later spent a month in hospital. He had to wait 2 years for therapy when he moved to adult services but feels it’ll help.

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Regarding my mental health issues, I was in the hospital for a month which is where I was first diagnosed with mental health problems and all my diagnoses took place. And then…But before then I was seen under CAMHS [Children and Adolescent Mental Health Services] just as a counselling service, if you know what I mean; just as like a support and just talking service. But then after I'd been put into this hospital for a month, then I'd been referred to the adult mental health service team, so yeah.

Was there a big difference between that transition to the adult mental health team from the, you know the children's or young people's?

Yes, it was, because I was getting cognitive behaviour therapy at the time, and unfortunately my therapist got ill and unfortunately she couldn’t do it anymore. But they said they would…they said as it was so close to that change…between that period of change over, between the CAMHS and the adult, they said that…they said it would automatically start up again when you come in the adult. But things didn’t work out and I'd been on the…I'd been in the adult mental health services for almost two years and I'm finally getting my first CBT appointment next week.

So you’ve been waiting for a good…?

Two years, almost two years yes.

Have you been able to access any similar services at all in any other way?

I've been …no, not really. I've been…my care co-ordinator's great, but she's not a therapist really. She's just like a care co-ordinator because she gives more practical advice on what to do and how to cope and stuff, but therapy is, I think, everyone says it's a way forward, so yeah, so...

So the care co-ordinator – is this through the GP or the hospital?

It's through… I first start…well I was in a CAMHS mental health unit when I was in hospital, so then I was diagnosed, so I had a formal psychiatrist up there, and when I got out and everything. But then my psychiatrist switched me to adults because I was over eighteen, I was getting to the age of eighteen, and so yeah so....
 

Auberon changed to another surgery because it was closer to college. He also liked that it was open 7 days a week from 8am to 9pm.

Auberon changed to another surgery because it was closer to college. He also liked that it was open 7 days a week from 8am to 9pm.

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I changed to [place name] Health Centre. I felt it was better for me because firstly my college is in [place name]; secondly it's open seven days a week. So it's a…yeah and it's also an NHS health GP practice, and it's also a walk-in centre as well. So, it's open seven days a week so, which is better for me so I can go on the weekend when I'm not at college or anything, so it doesn’t affect my college life. And then they did have online appointments booking service, it was like Vision Online and stuff.

And have you used the online?

I have, yes, and I found them very useful. And I can find that I can reorder my repeat prescriptions on there, and all of that.

That’s great. So how far is it, can you walk there or...

No, it's about a twenty minute bus ride.

Do you mind that or?

I don’t mind it all, no. As I said, I need to go to [place name] for college anyway, so it's about a ten minute walk from my college anyway, so....

And it's open seven days a week?

Yes.

And what times is it usually open?

It's open eight till nine.

8am till 9pm?    

Yeah.

Seven days a week?

Yeah

That’s very good.

Even on Christmas as well.

Really? Right.

It's one of the very few health centres that is open seven days a week as you probably may know, but yeah.

So how do you feel about that?

Good, yeah.

And your friends, do they all go to that one or?

We've recommended a few to…a few of them to it, but some are not in the catchment area of where it covers, if you know what I mean, because it only covers certain areas of…you can be registered here if you live within a certain area.
 

The GP spent 20 minute with Auberon, which gave them time to talk. The appointments with other doctors weren’t so good and lasted 5 minutes.

The GP spent 20 minute with Auberon, which gave them time to talk. The appointments with other doctors weren’t so good and lasted 5 minutes.

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And you mentioned that the good GP listened. Did you feel that you were given the time to talk?

Yes. This GP that I always see – normally the appointments are like ten minutes a session, but she always used to book double appointments for me to have time to talk to her and stuff. So she always used to give me twenty minutes a session so it gives us time just to talk about it and stuff.

Yeah, and you felt that she listened. So you felt that you could talk about what was on your mind?

Yes, yes.

She took you seriously?

Yes.

And have you noticed any changes like from sixteen to nineteen in terms of how the GP has talked to you, or has it always been the same?

It's always been the same really because I used to…because I've seen them by myself, so yeah.

And you feel confident enough to go and see them by yourself?

Yeah.

So that GP that you mentioned is good. She listened, and you made double appointments and you didn’t feel rushed at all?

No.

How about with the ones who weren’t so good?

The ones that weren’t so good only used to give me a single ten minute appointments, and some didn’t even used to be ten minutes. It used to be like five minutes. I would walk into a room and start explaining my mental health, and they would just…used to tell me to speak to my psychiatrist, so I just left.
 

Auberon’s GP is very supportive, listens, and referred him to a different psychiatrist when he was having problems with the first one.

Auberon’s GP is very supportive, listens, and referred him to a different psychiatrist when he was having problems with the first one.

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And in terms of seeing your GP, maybe talking about the anxiety and depression and things, have you found the GP to be helpful?

I have, yes. Some…I am…depends what GP you see really because some of them are really lovely and stuff, but some don’t even know what mental health illnesses are and just like think it's all a big joke and stuff. But I don’t…yeah so I try to see the GPs who understand me, but some…it's like pick n' mix really.

So, how would…is it quite…when you say hit and miss – different GPs every time you go or?

I can request a GP, but it depends on if they're working that day or something, or I might need to wait till a day that they are working to make an appointment with them on a day that they are working, so yeah.

And the GP that you like to make an appointment with most, can you talk a little bit about that GP – what's that GP like; what makes that GP good?

They are very supportive; they are very …they're very supportive, they are very …they understand me in terms of what I'm saying, and they are good listeners and that they try to go the extra mile in terms of how they can help. Because this GP will phone me whilst, when I was having a bad patch with my current, my old adult psychiatrist now, now she was trying to switch me to a different one, and so now that’s been put in place now so I've got a different psychiatrist, so yeah. 

So the GP that you like to see most, is that a male or female GP?

It's a female.

Female. And how long have you known her?

I have known her since I joined the… well not really because she joined…about a year, about a year.

And you said she's a good listener?

Yeah.

Understanding and she goes the extra mile?

Yeah.

Can you talk about that? What kind of things make a…when people say that she's gone the extra mile, what kind of things has she actually…do you feel she's done more than any of the others?

Yes, like I said, she referred me, she referred me to this…to another psychiatrist, and she was also trying to refer me as I didn’t get on with my…also my old care co-ordinator at the time. She was trying to switch me to a different team altogether, to the [place name] team, which is [place name] way, so it's not that far. So yeah, so she…as she used to work there in [place name], so she was trying to switch me to see if it would be the correct one for me.
 

The receptionist sometimes asks Auberon why he’d like to see the practice nurse. She doesn’t ask for many details, though, and is never nosey.

The receptionist sometimes asks Auberon why he’d like to see the practice nurse. She doesn’t ask for many details, though, and is never nosey.

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And when you go to the GP receptionist, does she ever say, "Oh what would you like to see the GP for?" Or anything like that?

She…only if you're a walk-in patient then yes, because you'll be seen by a nurse. So it would mainly be cuts, dressing changes, anything like that. But she wouldn’t go into a huge lot of detail about it. She wouldn’t need it. It's for the nurse to know. But say it was a cut, she would just put, 'Cut on leg' or whatever but that’s about it.

And so you feel comfortable about that?

Yeah.

You don’t feel in any way she's being nosey?

No, no, I don’t feel, because she's not going into too much detail about how you got the cut, or where did the cut from or…you know what I mean? Or was it self-harm, was it not, blah de blah de blah. So I think that should all be down to a nurse because…to ask her, or if a young person wants to tell the nurse, then they should definitely. But I don’t think that the receptionist, are being nosey at all, no.
 

Auberon once waited 8 hours to be seen as a walk-in patient. The nurse speaks to every patient first and decides if they need to see a doctor.

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Auberon once waited 8 hours to be seen as a walk-in patient. The nurse speaks to every patient first and decides if they need to see a doctor.

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I think they could have slightly more nurses working in terms of a walk-in centre, because every time I go there, there was all the chairs…it was like fifty chairs and they always used to be packed and people standing around, and it was always packed. So I think there could be less waiting…for most I had to wait for a walk-in centre was something like eight hours; eight hours. 

Eight hours?

So, yeah, so I think there could be more nursing staff or… to minimise the waiting time.

So some of the people could actually see a nurse instead of the GP?

Yeah, because it's run… my GP's run by a… it's a nurse led clinic, so it's run by nurses. So every walk-in centre, you get you would see a nurse first. And then if the nurse thought it was necessary, they would ask you to see a GP. 

But on, at weekends, it used to be within the area if you're within the age range. But, however, if you are a registered patient there you can go and see anyone you like really, depends on your appointments. But if you are just a walk-in patient who's from a different surgery, then you need to go and see a nurse first, and then they will tell you what to do next.
 

Auberon went to A&E after self-harming. The waiting time to see a GP or nurse was ‘ridiculously long’. He was referred to a psychiatric team.

Auberon went to A&E after self-harming. The waiting time to see a GP or nurse was ‘ridiculously long’. He was referred to a psychiatric team.

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And has the situation ever come along where you haven’t been able to make an appointment and so you’ve gone to A&E or any other out of hour's services in any way?

Oh yes. Well I would say yes, because regarding I self-harmed to do with my depression quite badly. So I was going to see my registered nurse or GP or someone, but I couldn’t make any appointments and the waiting time was just ridiculously long. So I went to A&E.

And was that helpful?

Yeah.

Did you see a good doctor?

I saw a good doctor and they also referred me to like the psych team who I know, and it's in my borough area. That in my mental health area catchment, so yeah.
 

More health services specifically for young people would be good, including youth centres providing support for mental and physical health problems.

More health services specifically for young people would be good, including youth centres providing support for mental and physical health problems.

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So if you feel more comfortable with people around your age group, do you think it could be helpful if they had specific times for young people's clinics; or any ideas on that kind of thing?

Specific time for young people? Yes, I think they could be like in terms of sexual health and stuff. There could be a sexual health clinic as the nearest one is about…it's about ten minutes on a bus from there so…and there's also a GUM clinic located at their sistering hospital, at the hospital they're twinned with. But there could be a sexual health clinic or some young people's clinic or something. Or even young people's mental health clinic I would say.

At the GP's surgery?

At the GP's surgery.

So if there was a mental health, a young people's mental health clinic there, you would find that helpful?

Yes.

And who would it be run by if there was one there, what's the best thing if they wanted to hear your views on the services?

Probably by a psychiatrist really, I would say by a psychiatrist who would answer any questions. They might not know the person but at least they would answer any questions they might have and stuff, or prescribe any one off medications, or any medications that they're currently taking that, if you know what I mean. That can only be prescribed by mental health professionals, who does it themselves, so yeah.
 

Younger people with mental health issues could benefit from talking to older people who’ve been through them too, maybe through instant messaging.

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Younger people with mental health issues could benefit from talking to older people who’ve been through them too, maybe through instant messaging.

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I think there should be like, even what if it's run by NHS, I think there should be like any mentoring session, like an older person would mentor online so it would all be confidential and they would all get their own username and you know what I mean. 

So it would all be confidential and no one would know where they would live, or any personal details about them. But if a younger kid just wanted to ask someone about a mental health, about an older person about their mental health experience or about an experience they're going through at the moment in terms of mental health, then that would be a very good way to ask them, because they will all remain confidential. No one would need to meet anyone face to face, and so yeah, so that would be…

So online, by email or instant messaging, or how would you say?

I was thinking of instant messaging of like a forum based website type thing. Because then, even if it's forum based, it would be like one response after another. Or they could also directly message…they might privately directly message the mentor themselves and ask them privately.

So would the mentor have any training as such?

The mentor would just be an older young person who had been through mental health problems before. And been all through the services and maybe not have training as such, but maybe have like things of what… not what to say on the site and to younger people and stuff. But I would think that they should…but the…but….sorry about that. I think that it would be that the older…that the younger person would benefit from hearing what the…of what the older person's views and experiences are.
 

Telephone consultations are good when Auberon wants to discuss his medications or mental health, but not if he needs to show the GP a physical problem.

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Telephone consultations are good when Auberon wants to discuss his medications or mental health, but not if he needs to show the GP a physical problem.

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Have you ever had one of those (telephone consultations) before?

I have, yes.

And did you find it helpful?

Yes I did, and if the GP felt it would be relevant for me to come in, he would book me an appointment that day.

So it's quite helpful to discuss what you're feeling?

Yeah.

And if he thinks it's relevant, only then would you go in, yeah.

Yeah, because it would save me a trip there and, you know, my time and, yeah.

Would you prefer to have a telephone consultation first every time?

Not really, no, because sometimes I would…I need him to physically see something, or if you know what I mean, so it would be better than me going in and stuff. But if it's just to discuss my mental health or my meds or something, then yeah, telephone consultations are good.

And is it usually with the GP that you like?

Yes.
 

It’s good when parents understand that their children might want to see the GP on their own.

It’s good when parents understand that their children might want to see the GP on their own.

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Parents – I feel like they should be like…they should let their young people, let their children see their GP if they need to see them, especially if there was like this young person's clinic, that they should let them see them by themselves, and without asking them what did you say to them. And if the young person feels comfortable telling them, then they should be able to tell them. But if they don’t, then they shouldn’t bother them or hassle them.
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