RURAL GPs in Cork are referring more people to hospital with mental health issues as a result of the coronavirus pandemic, according to a rural GP.
Bantry GP Dr Paul O’Sullivan said rural family doctors have noted an increase in the number of people attending with mental health issues in rural Cork, as well as an increase in the severity of their conditions, over the past six months or so.
While Dr O’Sullivan said this is not limited to rural settings and is also being noted in urban areas, it is particularly severe in rural areas where social isolation and lack of support is prevalent.
“There are also a lot more mental health problems presenting at general practices, with many people under a lot of stress and strain,” said Dr O’Sullivan.
“We have noticed a significant increase in mental health problems with anxiety, stress, depression all to the fore.
“The social glue that kept people going is now gone basically and people, especially elderly people, are very lonely and isolated,” he added.
“Not being able to attend family gatherings, birthdays, christening, weddings and more does have a cumulative effect and we are seeing people now who are under a lot of stress and strain due to not seeing loved ones.
“This can be more prevalent in rural areas where people might not be able to see neighbours, go to the pub because it’s closed down or go to mass because of the limits there.
“It is a very big issue in rural areas because people’s opportunities to interact with each other may be fewer than those in city settings.
“It reminds us of horror films like 28 Days Later where people have become so cut off from society and so fearful of it, that they’re afraid to come to their door.
“I have seen that paranoia where people would literally not come to their door for fear something might happen and that they might catch something.”
Dr O’Sullivan highlighted the need for resources to be allocated towards supporting people mentally and emotionally following the unprecedented lockdown, labelling it an “unmet need”.
“Some clinics have been cancelled and some people are only being spoken to over the phone, which isn’t the best way of dealing with this.
“You can pick up a lot from a person’s cues and facial expressions that can’t be picked up over the phone.
“If somebody does have significant mental health problems, the fact that they’re physically isolated does add to that strain and we have noticed that admissions for mental health issues have increased.
Dr O’Sullivan also highlighted the impact of recent restrictions on carers across Cork.
“The amount of residual stress on families who may be looking after people with dementia, psychological issues or learning disabilities is also building up because the supports and social interactions they usually had are gone and they now feel very much alone,” he said.
“That has significant implications as well.”
The Bantry GP also admitted that doctors now fear that, concerned about possibly catching Covid-19, patients have delayed treatment for issues they usually would have brought to their doctor.
“Certainly the pandemic has thrown everything up in the air,” he said. “Whereas before people would have been sitting cheek to jowl in GP waiting rooms, we now have strict guidelines to follow which limits the amount of people that can come in.
“With Covid-19, we are seeing that people are afraid to come to GP surgeries for fear of coming into contact with someone who has it. That has an effect on people who we would normally see and now we don’t.
“That would make us fear that there is a lot of unknown illness and unseen conditions that are not being picked up and treated, and that people are suffering as a result.
“Fear of the coronavirus has overwhelmed people’s normal healthcare-seeking behaviour.”
Dr O’Sullivan also raised concerns about the phased plan to extend free GP to all children under the age of 12, which was introduced in June this year, and the impact this will have on elderly patients who may already be suffering.
“Unfortunately, there is a limited number of slots available to see people,” he explained.
“Parents can bring in children with minor, self-limiting illnesses seeking assurances and they’re going to be able to access appointments easier than the elderly population because they’re better at using technology to gain access.
“Unfortunately, we are seeing that people are being crowded out of being able to get appointments because some are using their elbows and knowledge of technology to get ahead. As a result, elderly people, who are more at risk, are losing out and there is a fear that we will end up with a vastly underserved elderly population that’s unable to access services because the worried parents are taking more and more of the available slots.”
Dr O’Sullivan also explained that, as well as the patients, the pandemic has impacted rural general practice in unprecedented ways.
“The Covid pandemic has put increased stress on primary care and that is only hastening the decline of the workforce,” he said. “It’s very difficult to attract GPs to rural areas when they know they might be the only person there to go out and expose themselves to danger on a day-to-day basis with very little support from the health service.
“It’s a very difficult sell to attract young GPs to come to rural areas when they know they’re it, that thin blue line on their own.”
Dr O’Sullivan said this scenario is also hastening the exit of GPs who are nearing retirement age.
“Certainly, from speaking to peer groups and GPs nearing retirement age, it’s clear people are becoming quite vocal about being open to taking early retirement,” he said. “The pressure that was coming at us on a day-to-day basis has taken its toll and many would gladly take early retirement as a result.
“A lot of my colleagues haven’t taken holidays since the pandemic began.”
“This entire pandemic has put increased pressure on rural GPs that is adding to the pressure cooker already present.”