Mental Health Stigma is still strong in the UK - Dr. Afiniki Akanet FRCGP

The Editor-In-Chief had an interview with a UK-based General Practitioner
(GP/family doctor) and academic, Dr. Afiniki Akanet FRCGP – Afiniki.co.uk.
Below are the excerpts:
AMH: What motivated you to choose mental health as your General Practice (GP)
special interest?
Dr. Afiniki Akanet: I came to the UK from Nigeria as an international student in 2000
without my parents and siblings. It was a tough time when I had to look after my mental
health to be able to stay focused and well, despite the financial challenges I faced. I
quickly learned the value of good mental health, especially in African communities
where a lot is expected of us from a young age. After completing my medical degree, I
was blessed to have several psychiatry rotations as part of my Foundation and GP
training. Some GPs do not get even one mental health rotation, but I had three! I
enjoyed working in psychiatry but knew that my personality was more suited to GP,
which is why I chose to train as a GP and build a special interest in mental health, which
has proved very useful over the years. I have worked with and learned from many
psychiatrists, giving me important skills to help mental health patients in the community.

AMH: How is life like in academia?
Dr. Afiniki Akanet: It was my love for having variety in my working week that led me to
take up a part-time academic post in 2024 after I finished working at an Eating
Disorders unit, as part of my mental health special interest. I currently teach on the
prescribing course for Allied Health Professionals at a local university, and it has been
very rewarding. I enjoy sharing my knowledge and experience with individuals who
appreciate it and are eager to develop professionally. I am blessed with great university
colleagues who appreciate my contributions as an experienced GP in academia. There
can be busy periods of juggling lectures, marking exams, and supporting students as their Academic Assessor, as well as my clinical work in GP. Still, I like the variety,
challenge, and opportunity to keep learning through my work.

AMH: Does the National Health Service (NHS) address all the needs of mental health
patients in the UK?
Dr. Afiniki Akanet: I do not think that any healthcare system can address ALL the needs
of mental health patients, but the NHS tries, despite the financial and manpower
challenges. Mental health patients in the UK get pharmacological and psychological
treatments which are free at the point of delivery. There are currently long waiting times
for many services, but we also have crisis teams and emergency/999 services for those
in distress. The mental health teams work closely with Social Services and the police to
support mental health patients, who sometimes do not have family support. A lot more
can be done to support mental health patients in the UK, but staff shortages and lack of
funds are sadly affecting every part of the NHS at present.

AMH: What is the ratio of psychiatrists to patients in the UK?
Dr. Afiniki Akanet: There is a severe shortage of psychiatrists in the UK at the moment,
with around 8 psychiatrists per 100,000 people, depending on the location. Knowing
that one in four people in the UK experience a mental health problem every year, and
there is only one psychiatrist for around 12,500 people, there will be a strain on
services, deterioration of patients, and stress on healthcare professionals. I know that
the shortage is much worse in Africa, but such numbers make it difficult for people to
access assessment and diagnosis promptly. This is one of the reasons why I
am keen to keep on developing my expertise in mental health.

AMH: What is the level of stigmatisation of the mentally challenged in the UK, and how
can it be totally eradicated?
Dr. Afiniki Akanet: The mental health charity, Mind, reports that half of UK adults say
that mental health stigma is still strong. Most people with severe mental illness in The
UK report is experiencing stigma and discrimination affecting access to support, housing,
jobs, and even healthcare. The internalised stigma also makes patients and their
families reluctant, ashamed, or embarrassed to reach out for help with mental health
problems. As this stigma is deeply entrenched in society, probably more strongly in
ethnic minority communities, we can keep trying to reduce it through public health
education, campaigns, and policies. Still, I think it will be difficult to totally eradicate
mental health stigma because of how self-centred humans can be. Sadly, most people
will only truly empathise when something directly affects them too.

AMH: Is it possible for patients to get weaned off medications in the UK?
Dr. Afiniki Akanet: Yes, I teach my university prescribing students the dangers of
polypharmacy and encourage them to have regular medication reviews with patients, so
that we can stop medications that are no longer needed. Mental health patients are
often on medication for years, but these can be reviewed when they are stable to decide
if they might be okay without some medications, such as antidepressants. Patients are
strongly advised not to come off mental health medication without support from their
healthcare team, because there are a lot of factors to be considered when considering
weaning patients off medication. Some patients might need to stay on certain
medications for life, and that is okay, especially if it allows them to function and have a
better quality of life.
AMH: What is the role of psychologists in the care of patients in the UK?

Dr. Afiniki Akanet: I always tell patients that medication is only part of their treatment
because our minds are not machines. Most mental health patients will also need
psychotherapy (talking therapy) to treat their condition, which is usually where
psychologists come in. There is sadly also a shortage of clinical psychologists, but they
are important members of the Multidisciplinary Team (MDT) for supporting and treating
mental health patients.
AMH: Is the workplace really supportive of mental health patients in the UK?
Dr. Afiniki Akanet: As I said, there is still some stigma in the workplace, but we have
employment laws and policies that protect workers with mental health diagnoses.
Ignorance is no longer an excuse for workplace discrimination, because most
Employers provide training on diversity, inclusivity, and the bystander effect. We cannot
always control how people behave towards their colleagues, but raising awareness of
mental health issues, and having clear policies against discrimination makes the workplace more conducive for people with mental health problems who want to keep
working and contributing to society when able.
AMH: How can patients better manage the side effects of their medications in the UK?
Dr. Afiniki Akanet: It is important to have regular medication reviews with your doctor or
other mental health professional, which will pick up long-term side effects, for example,
from blood tests and physical health checks. Some medications can affect blood
pressure, weight, liver function, and even sexual function. Patients should contact their
prescriber for a consultation if they are experiencing any unpleasant effects from
medication, because we can offer alternatives or change the dose. Having a healthy
lifestyle can also reduce the risk of obesity and other side effects. Sometimes, it is a
balance of risk versus benefit (especially when we do not have many medication
options available), so patients might choose to live with certain minor side effects to
prevent major breakdowns or distress. Reporting medication side effects also helps with
drug monitoring and research.