Providing Holistic Primary Health Care

Case Study Submitted by: Melanie Rogers
Country: Great Britain

James is a 43-year-old engineer. He is married with three children and had an active interest in cycling and hiking before his illness. He presented to Melanie Rogers with symptoms of depression. He could not identify any triggers but had noticed low mood, anhedonia, poor concentration and a loss of hope, meaning and purpose in his life. He felt he was worthless. He was still working when he met Dr Rogers, but had stopped cycling and hiking, and spent much of his time worrying about the future.

Dr Rogers spent the appointment just listening to James, asking salient questions to assess his mood as the consultation continued. Her approach to mental health issues is to create a safe environment where her patients can share their concerns and feel listened to and accepted. James was able to talk about his depression but was very tearful and felt ashamed of feeling this way. Dr Rogers reassured him that depression was a very common presentation and there were many options available to him. She assessed his mental health through therapeutic conversation and was able to ascertain that although he appeared to have moderate depression, he had no suicidal ideation or intent. Dr Rogers gave him some information to read on depression and arranged to see him later that week for a longer appointment.

Dr Rogers sees patients with depression on a regular weekly basis to build a trusting relationship and offer support, care and treatment until they are stable. Before James saw Dr Rogers again he completed a depression assessment tool which showed he had moderate to severe depression.

At the second consultation, Dr Rogers talked through options for James and he decided to start anti-depressants and cognitive behavioural therapy. She saw James regularly over a year in which time she helped him to begin to restart activities he enjoyed which had given him purpose. She also helped him to look at changes in his life, which led to more enjoyment and pleasure. He appeared to be doing very well until a friend was killed in a car accident.

James was badly affected by the loss and had a relapse of his depression as he struggled to understand and grieve. Dr Rogers consistently monitored his mental health and noticed him becoming more withdrawn. He admitted to feeling actively suicidal and was referred to secondary mental health services who assessed him and recommended counselling. The counsellor assessed James and said he was too severe for the counselling service due to feeling suicidal. James felt caught between the services. Dr Rogers acted as his advocate and saw James every few days during this time. Over the next month he talked to her about his grief and suicidal thoughts, she accepted him and provided consistent care. Over time his depression lifted.

James came back to see Dr Rogers recently and said he felt the care provided by her had saved his life. He felt she had been there consistently and accepted him fully. He felt her care, kindness and compassion had enabled him to have hope. His experiences of other mental health services had caused additional trauma but through Dr Rogers’s support he had regained a sense of wellbeing.

Dr Rogers’s approach was based on holistic care which addressed the bio-psycho-social- spiritual aspects.  She simply provided a safe place where James could be honest about his symptoms and concerns. She then provided options in treatment and consistently supported him back to health.

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