What is Stress?
Diagnosing Stress
The GAD-7 questionnaire (the screening tool for Anxiety disorders) and the PHQ-9 questionnaire should be conducted as there is much overlap between anxiety/depression and stress.
Penrose Health Action Plan
We aim to keep the number of Mental Health Nurse visits to a maximum of 6 per patient in any given episode. See Schedule of Reviews below for more specific/detailed guidance.
⚠️ Safety netting
If there is any consideration of prescribing medication for current symptoms → reconsider diagnosis/pathway, as medications are not licensed for use in treating stress.
If at any time a patient presents:
- with a significant change in risk status; or
- if there is a commencement/change in medication
The visit count resets back to the beginning (i.e. First review)
Secondary and External services may be better placed to help/support patients than we are.
- Secondary services offer psychological treatments (e.g., interpersonal/psychodynamic therapies, CBT)
- External services in the community offer many options for social and psychological help through relationships with the wider service network (e.g. Social Prescriber, Befriender, Care Coordinator, Therapist, Lifestyle Coach, etc.)
We do not provide any form of psychotherapy within our surgeries.
Patient Journey - Determining Schedule of Reviews
Click toggle for a schematic of the action plan/treatment policy for all Penrose Health Surgeries, or follow the guidance below.
If considering medication for patient → perform assessment for any concurrent diagnosis (e.g. Depression, Anxiety, ASD, etc.). If assessment/history suggestive → rebook and follow that pathway.
If no other concurrent diagnosis and patient not managed in secondary service → consider following and review in 4-6 weeks:
- social prescribing and/or signposting to community services if major social stressors (see Booking a Care Coordinator Appointmentand Social Prescribing for more information).
- giving advice regarding general healthy lifestyle (e.g. exercise, sleeping well).
- If a patient is actively managed by another mental health provider → liaise with services as required and conclude routine MHN appointments.
- If rejected by secondary services and patient is at high risk → review again in <1-2 weeks.
Patient is stable/improving → conclude routine MHN appointments.
Patient’s mental health worsening → reconsider clinical impression (e.g., perform assessment again for depression, anxiety, etc.).
- if clinical impression changes → rebook and follow that pathway.
- if clinical impression does not change → review in 1 -2 months
Patient is stable/improving → conclude routine MHN appointments.
Patient’s mental health worsening → book for clinical review with GP.
Referring/Signposting Onward
Below are some services to which you can signpost/refer patients. More services can be found on the Penrose Portal in Mental Health Services Database.