I work as a GP in a diverse urban practice of over 17,000 patients. We are situated in a relatively deprived part of Bristol with pockets of affluence. We have patients from many different ethnicities including those from EU and non-EU countries as well as a large cohort of university students. A significant bulk of our work involves dealing with mental health problems.

Mental health services across the country are very patchy: in some areas there is no easy access to psychiatrists, and long waiting times for cognitive behavioural therapy (CBT) or counselling.

Yet statistics suggest one in

four people in the UK will suffer with a mental health problem in their lifetime. It is the largest single cause of ill health – 28% compared to 16% each for cancer and heart disease. Yet, around three-quarters of these patients will receive no treatment at all. 10% of children and young adults have a mental health problem yet over 70% receive no treatment for this. GP consultations for depression have risen since the financial crisis, and poorer and more disadvantaged people are disproportionately affected.

In recent weeks, even in my own practice, I have seen more patients who have previously not attended coming in with anxiety and low mood symptoms following the Brexit vote. When I first started working here in 2010 we were already seeing escalating anxiety and depression following the financial crisis of 2008 and steep cuts to social care and NHS. But now we have reached a point where access to mental health services for adults and children is so limited that it is no longer safe for patients.

Sam is 33 and suffers from severe anxiety and depression – he has major mood swings and has been unable to hold down a job since he first became unemployed five years ago. He was working as a manager in a garment factory until he was made redundant. He lives alone in sheltered housing. He is isolated and will go days without eating or leaving his flat. His only human contact is the weekly visits of his support worker who will do his food shopping and sometimes bring Sam to see me at the surgery. Sam did have a CPN (community psychiatric nurse) a few years ago until he was discharged from her care because he was deemed “well” and not in need of acute medical intervention.

The reality is that Sam is not well. I have only seen him get more ill and marginalised from society over the years with no way of coming back. I have tried and failed on several occasions to access ongoing mental health support for him. But, sadly, it takes a crisis for him to be seen acutely by the mental health team.

When Sam starts to have paranoid ideas, hearing violent voices in his head that tell him to stop eating and to hurt himself he is sectioned under the mental health act. He is now an inpatient 200 miles away in an acute psychiatric ward.

Every day I see around two patients with severe mental health problems who I can’t get any help; there are others who won’t come in to the surgery at all but I don’t have the experience, or backup, to see them at home. I have not trained in mental health. Most GPs do not work in psychiatry although we will all gain experience through our day-to-day work. Until recently we had no access to our own CPNs, nor are we able to consult with a psychiatrist easily for advice. Our GP practice has just been allocated a CPN as part of a 12-month pilot and she is able to see patients on the milder ends of the anxiety and depression spectrum. I do not know if we will be able to secure any funding for this after the pilot ends.

Mental health teams work very hard and are stretched to the limit with often little choice but to discharge patients to the GP before they are well enough or ready. The system is broken and although we are seeing an acknowledgment of the scale of the problem by the government, I am not convinced that it has any workable solutions. We could certainly make a start with a CPN and social worker for every practice, an accessible community psychiatrist for advice and even GP training posts to include more experience in psychiatry.