Mental Health
Around a third of GP appointments involve a mental health component.
Learn a structured approach to low mood, talk about risk with confidence, try the PHQ-9, review key NICE guidance and test yourself with real-world scenarios.
The Mental Health Consultation
Tap each stage to see how to structure a safe, compassionate consultation about low mood or anxiety.
Engage Build trust first
Give the patient time and space. Use open questions, acknowledge how hard it can be to talk, and pick up on cues.
- Open questions
- Empathy and validation
- Silence is useful
Explore Understand the picture
Explore symptoms, duration and impact on daily life, work and relationships. Ask about sleep, appetite, alcohol and drugs, and any past episodes.
- Core symptoms and duration
- Function and impact
- Alcohol, drugs, past history
Ask About Risk Be direct and kind
Ask directly about thoughts of suicide and self-harm. Asking doesn’t increase risk, and it’s often a relief for the patient to be asked.
- Thoughts, plans, intent
- Protective factors
- Risk to others
Plan Agree next steps
Agree a plan that fits the severity and the patient’s preferences, such as guided self-help, talking therapies or medication, in line with NICE stepped care.
- Patient preference
- NHS Talking Therapies
- Medication if appropriate
Safety-Net Keep them safe
Agree a safety plan and make sure the patient knows where to get urgent help, then arrange a timely follow-up.
- Personal safety plan
- Crisis contacts
- Clear follow-up
Talking About Risk
Five principles for discussing suicide and self-harm safely, informed by NICE guidance on self-harm (NG225). Tap each card to reveal it.
Try the PHQ-9
Practise scoring the PHQ-9 with a made-up patient. Over the last 2 weeks, how often have they been bothered by the following?
- 1. Little interest or pleasure in doing things
- 2. Feeling down, depressed or hopeless
- 3. Trouble falling or staying asleep, or sleeping too much
- 4. Feeling tired or having little energy
- 5. Poor appetite or overeating
- 6. Feeling bad about yourself, or that you are a failure or have let yourself or your family down
- 7. Trouble concentrating on things, such as reading or watching television
- 8. Moving or speaking so slowly that other people could have noticed, or the opposite: being so fidgety or restless that you have been moving around a lot more than usual
- 9. Thoughts that you would be better off dead, or of hurting yourself in some way
0 / 27
Answer all nine questions to see the severity band.For education only. The PHQ-9 supports clinical judgement but doesn’t make a diagnosis on its own.
Key Guidance at a Glance
Choose a topic to see the essentials to know for practice and the SCA.
Depression
- NICE NG222 groups depression as less severe (PHQ-9 under 16) or more severe (16 or over)
- For less severe depression, offer guided self-help, group CBT or behavioural activation, or exercise. Don’t routinely offer antidepressants first line unless the patient prefers them
- For more severe depression, offer a choice of combined CBT and an antidepressant, individual CBT or behavioural activation, or an antidepressant
- Review people starting an antidepressant within 2 weeks, or within 1 week if under 25 or at increased risk of suicide
- Patients can self-refer to NHS Talking Therapies in England
Based on NICE guideline NG222.
Anxiety (GAD)
- Use a stepped-care approach, starting with education about the condition and active monitoring
- Offer low-intensity psychological interventions, such as guided self-help or psychoeducation groups
- If symptoms persist, offer high-intensity CBT or applied relaxation, or drug treatment
- Sertraline is the recommended first-line drug
- Don’t offer benzodiazepines except short-term during a crisis
Based on NICE guideline CG113.
Self-Harm
- Treat everyone who has self-harmed with compassion and respect
- Assess physical health needs first, including any need for urgent hospital care
- Carry out a psychosocial assessment focused on needs, not a risk score
- Don’t use risk tools or scales to predict future suicide or self-harm
- Work on a safety plan and follow local pathways for urgent mental health assessment. Consider safeguarding for under-18s
Based on NICE guideline NG225.
A summary only. Always check current NICE guidance, NICE CKS and local mental health pathways.
Test Yourself With Scenarios
Five common mental health scenarios. Choose an answer to see instant feedback.
Q1. A patient with low mood mentions feeling “there’s no point anymore”. What should you do?
Asking directly about suicidal thoughts doesn’t increase risk and is an essential part of the assessment.
Q2. A 22-year-old starts sertraline for depression. When should you review them?
NICE NG222 recommends review within 1 week for people under 25 starting an antidepressant, because of a possible increase in suicidal thoughts.
Q3. A patient with GAD hasn’t improved with guided self-help and chooses medication. What’s the first-line drug?
NICE CG113 recommends sertraline as the first-line drug for generalised anxiety disorder.
Q4. A patient attends after an episode of self-harm. How should you decide what support they need?
NICE NG225 advises against using risk tools to predict suicide or decide on treatment. Focus on needs and safety planning.
Q5. A patient has less severe depression (PHQ-9 of 12) and doesn’t want medication. What would you offer?
For less severe depression, NICE NG222 recommends psychological and psychosocial options first, respecting patient preference.
Keep Learning
This guide is for education only. Always use your clinical judgement and check current NICE guidance, NICE CKS and local pathways.
Need support yourself? If you’re struggling, you can call Samaritans free on 116 123, any time. In England, call NHS 111 and choose the mental health option, or call 999 in an emergency. Doctors can also contact NHS Practitioner Health.