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Welcome to Mental Health

Mental Health (MH)

  • Mental health is a fundamental component of general practice influencing all aspects of patient care. GPs are often the first point of contact for patients experiencing psychological distress. This may present overtly or become apparent during consultations for physical complaints, highlighting the importance of developing strong skills in recognising and managing mental health concerns with a holistic, patient-centred approach. Depression, anxiety, stress-related conditions, substance misuse,   psychotic illnesses and personality disorders are commonly encountered in primary care. Much of mental health can be managed in primary care, however, more complex presentations may require shared care with specialists. Early identification and treatment, effective communication, and ongoing support are key to effective management. GPs also play a vital role in suicide prevention, through comprehensive risk assessment, timely crisis intervention, and  coordinated collaboration with mental health services.. Understanding the social determinants of mental health, promoting wellbeing, and reducing stigma are essential to delivering holistic, person-centred care throughout a patient’s lifetime.  

    • MH1. Identify, assess and manage mental health conditions across all age groups, considering the interplay of biological, psychological, social, and environmental factors.
    • MH2. Differentiate between normal emotional responses and diagnosable mental health conditions in children, adolescents, and adults.
    • MH3. Conduct a suicidal risk assessment.
    • MH4. Demonstrate competence in managing mental health conditions commonly encountered in primary care.
    • MH5. Demonstrate an understanding of the role and effectiveness of evidence-based talk therapies (e.g., CBT, CBT-E, DBT) in the treatment of mental health conditions, and prioritise timely referral to these interventions to optimise patient outcomes and consider them as first line treatments before pharmacological options when clinically appropriate.
    • MH6. Provide evidence-based care for individuals with mental health problems, recognising the limitations of clinical trials and the complexities of primary care settings.
    • MH7. Develop a patient-centred and compassionate approach to mental health care, addressing the needs of patients and families with empathy and respect.
    • MH8. Understand and address the comorbid physical and mental health needs of patients with severe mental illness, recognising the increased risk of cardiovascular disease, metabolic syndrome and other co-morbidities.
    • MH9. Develop strategies for managing patients presenting with self-harm or suicidal ideation, ensuring appropriate support for individuals and their families.
    • MH10. Demonstrate competence in managing patients who present with violent or aggressive behaviour, prioritising safety while providing appropriate care and support.
    • MH11. Analyse the use of psychotropic medications, ensuring appropriate prescribing, dosage selection, and monitoring of potential side effects.
    • MH12. Coordinate mental health care effectively, collaborating with other professionals and understanding the role of various support services.
    • MH13. Understand and apply relevant legal frameworks in mental health care with particular attention to the GP’s role in involuntary admissions.

    For each problem or disease, consider the following areas within the general context of primary care:  

    • The natural history of the condition, including whether acute or chronic
    • The incidence and prevalence, including in different demographic groups
    • Typical and atypical presentations
    • Recognition of normal variations throughout life
    • Risk factors, including lifestyle, socio-economic and genetic factors
    • Diagnostic features and differential diagnosis
    • Recognition of ‘alarm’ or ‘red flag’ features
    • Appropriate and relevant investigations
    • Interpretation of test results
    • Management, including initial and continuing care, chronic disease monitoring and emergency care
    • Patient and carer information and education
    • Prognosis

    Signs, Symptoms & Presentations

    Below is a list of common presentations or symptoms that may represent mental illness. The role of the GP is to differentiate between stress, distress, mood disorder and diagnosable mental illness, working with the patient to agree what the problem is and management options.

    • Acute Confusional State
    • Anger
    • Anxiety
    • Delusions
    • Fatigue/ Tired all the time
    • Hallucinations
    • Irritability
    • Memory disturbance
    • Poor Concentration & motivation
    • Psychomotor agitation/ retardation
    • Psychosis
    • Self Harm
    • Sleep Disturbance
    • Stress
    • Suicidality
    • Thought Disorders
    • Unexplained physical symptoms

    Common and Important Conditions

    • ADHD
    • Adjustment Reactions
    • Anxiety Disorders including Generalised Anxiety Disorder, Panic Disorders, Phobias, Social Anxiety Disorder etc
    • Bipolar Disorder
    • Body dysmorphic disorders
    • Delirium
    • Depression
    • Eating Disorders including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder etc
    • Insomnia
    • Mania
    • Obsessive Compulsive Disorder
    • Panic Disorders
    • Personality Disorders
    • Post Traumatic Stress Disorder
    • Pregnancy associated disorders - antenatal, perinatal and postnatal anxiety and depression, puerperal psychosis
    • Schizophrenia
    • Situational Anxiety

  • Wherever possible learning resources included here are peer reviewed and externally maintained. This is to ensure that trainees have access to quality assured information that is kept up to date.

    Self-Directed 

    Workplace Based Learning

    Workplace-based learning in mental health offers real-world opportunities across diverse clinical settings. In general practice, trainees encounter a broad range of acute, chronic and emergency mental health presentations, from anxiety and depression to crisis episodes, often within the context of long-term physical illness or social stressors. Community psychiatry placements allow for deeper engagement with multidisciplinary teams, complex case management, and recovery-oriented approaches, while inpatient psychiatry offers exposure to acute presentations, risk assessment, and the use of mental health legislation. Across all settings, supervised consultations, case-based discussions, and reflective practice support the development of clinical confidence, communication skills, and a holistic, compassionate approach to mental health care.

    Day Release

    Day release teaching provides a valuable space to explore mental health topics in greater depth, away from the pressures of the clinical environment. Through case-based discussions, role play, and peer reflection, trainees can build confidence in recognising, assessing, and managing a wide range of mental health conditions commonly seen in general practice, such as depression, anxiety, self-harm, substance misuse, and psychosis. These sessions also offer an opportunity to discuss complex or emotionally challenging cases, share approaches to risk assessment and safety planning, and review local pathways for referral and support.

    Registrar Tutorials

    Registrar tutorials offer a supportive and interactive setting to deepen understanding of mental health in the context of general practice. These sessions can focus on common presentations such as anxiety, depression, and insomnia, as well as more complex issues like psychosis, self-harm, personality disorders, and safeguarding concerns. Tutorials are ideal for exploring real cases, practising communication techniques and reviewing mental health legislation and local referral pathways. They also provide a space for reflective discussion around professional boundaries, emotional resilience, and managing the impact of challenging consultations on the clinician.

  • Entrustable Professional Activities (EPAs) underpin workplace-based assessment in this curriculum. Each EPA represents an integrated clinical task that General Practitioners must perform safely and independently, assessed through direct or indirect observation in real clinical settings.

    The curriculum and EPA framework are closely aligned: the curriculum defines the required knowledge, skills, and professional behaviours, while EPAs assess their application in practice. Together, they create a coherent approach to developing and demonstrating readiness for independent clinical work.

    The examples show how specific activities within general practice & chapters of the curriculum align with particular EPAs.

     EPA 12: Manage the mental health needs of adults including older people

    A patient presenting with low mood, anhedonia, and passive suicidal thoughts provides an opportunity to demonstrate EPA 12. If the GP Trainer observes the consultation, a PIP-C can be used to assess risk assessment, exploration of comorbidities, and development of a collaborative management plan. A succinct case entry could be: “assessment of low mood and suicidal ideation.” Reflection should explore safety planning, clear documentation of risk, consideration of non-pharmacological interventions, and strategies for supporting families.

    Core Knowledge Test (CKT)

    • Antidepressant prescribing

    • Management of new-onset psychosis

    • Risk assessment of a patient with suicidal ideation

    Clinical Competency Test (CCT)

    • A patient presenting to the surgery tearful with low mood.
    • A patient with a diagnosis of Bipolar Affective Disorder presenting for review.
    • A patient presenting for review of their SSRI medication.

    Disclaimer: The examples provided within this section are intended to be indicative only and are included to illustrate how elements of the curriculum may be assessed in the Clinical Competency Test (CCT).

    Examination questions in the CCT test the ability of candidates to integrate knowledge, skills, and professional behaviours across multiple curriculum areas to address the challenges posed by the question.

    The indicative content should therefore be used solely as a general guide as to some of the topics that may be introduced. Actual examination questions will assess a greater depth and complexity of understanding than the illustrative examples provided.

    Please note that a number of CCT questions will require candidates to undertake a physical examination of the simulated patient. In some circumstances, for example in the case of an intimate examination, candidates may be required to display their examination skills through use of a manikin or other device.