It can be difficult to live with pain and it is not uncommon for patients consulting with pain to be low in mood or to have some anxiety. It is likely that some patients will have mental health problems unrelated to their pain. Some of this information may be gathered from their responses to the Pain Concerns Form. Some patients with mental health problems both related and unrelated to pain will have a good awareness of their condition with helpful strategies and robust support, but this may not be the case for all patients.
We suggest you approaching mental health problems in the same way we have outlined for assessing pain. You could start by validating their experience and ask open questions to get a better understanding. For example,
Validate: “You’ve told me [that the pain gets you down/ that you’ve struggled with anxiety before] and that must make it harder to cope with the pain.
Ask: How would you feel about [getting more support/ learning different ways to manage] your mood?
Assessing risk in patients who are low in mood
During a consultation, a patient may reveal suicidal thoughts, or may be particularly low, depressed and/or withdrawn during a consultation. If a patient reveals suicidal thoughts, or is particularly low, depressed and/or withdrawn during a consultation, let them know that you are listening to them and ask them more about the thoughts they are having. Take them seriously and in discussion with the patient make a plan to discuss the case with the GP.
Take a look at the flowchart below that outlines what to ask patients if they reveal a current risk of suicide and what action to take if needed.
In later lessons, we will outline when it would be important to collaborate with the GP about a patient’s mental health and the next steps you could take when the patient is not at immediate risk.