Can This Possibly Be Correct?!

[OceanDweller]

Hello All

Earlier this week I had cause to contact the Community Mental Health Crisis Team because I had serious concerns for the wellbeing of a close family member.

After (finally... following an unjustifiably complex process) being directed to the appropriate department, I was advised that the Crisis Team would refuse to offer support as the individual is currently under the care of their GP, and not the Primary Care Team. My only option, I was told, would be to call 999.

Am I completely crazed, or is this woefully inadequate and bordering upon professional negligence? If someone is in crisis, why would the Crisis Team not provide support? I'm canvassing opinion before I launch into what I'm sure will develop into a protracted, frustrating, potentially fruitless, but all the same wholly satisfying tirade.

Thank you in anticipation for your input.

Edited August 16, 2017 by OceanDweller
Grammar

[Taffy]

Ridiculous but true I think, you need a referral to them, either GP or CMHT.

[Ashley]

If I am honest I am not entirely sure on the process for crisis team referral to comment if this is right or wrong, but it does sound frustrating.  But can the GP not refer the person to the mental health services for crisis team access?   

[OceanDweller]

10 minutes ago, Ashley said:

If I am honest I am not entirely sure on the process for crisis team referral to comment if this is right or wrong, but it does sound frustrating.  But can the GP not refer the person to the mental health services for crisis team access?   

Hi Ashley. I live hundreds of miles from the relative in question. They had expressed thoughts of (and plans for) suicide, and their private therapist had contacted me to express concerns. It was a Friday night and impossible (for reasons I won't bore you with) for me to make the journey. All I wanted was for a visit to be paid over the weekend. Impossible, it would seem. But yes, reengagement with the CMHT was facilitated on Monday via their GP. The only consequence (mercifully) was a weekend of anxiety and frustration.

[OceanDweller]

16 minutes ago, Taffy said:

Ridiculous but true I think, you need a referral to them, either GP or CMHT.

Thank you for the information Taffy.

[snowbear]

Hi OceanDweller,

I'm sorry to hear a family member is going through a difficult patch. Thankfully the weekend passed without incident and hopefully your relative is now getting the help he/she needs, but it must have been a frustrating and anxious time.

For future reference the first time you need 'crisis' input you have to call your GP (or out of hours GP if your normal surgery isn't open.)

It may seem a daft system, but there are good reasons why people can't self-refer to the Crisis Team. 

It's the GP's responsibility to make an initial assessment and decide what the appropriate management should be. That could be home care with supervision by a relative, medication, hospital admission (voluntary or involuntary) or referral to the Crisis Team for additional support while remaining in the community. It's not the job of the crisis team to make that initial decision on what is appropriate management (though they can make similar decisions in future once a patient has been assigned to them.) 

It may seem to the public to be a convoluted way of going about it, but it comes down to whose responsibility it is to assess and diagnose and for that the buck stops with the GP. (The responsibility 'buck stops here' issue is partly why doctors get paid huge sums and other, equally capable, members of the team get paid less. Such is the way of the western world.)

Once someone is under the care of the crisis team, then further 'crisis' incidents can be managed with a direct call to them. 

[OceanDweller]

3 minutes ago, snowbear said:

Hi OceanDweller,

I'm sorry to hear a family member is going through a difficult patch. Thankfully the weekend passed without incident and hopefully your relative is now getting the help he/she needs, but it must have been a frustrating and anxious time.

For future reference the first time you need 'crisis' input you have to call your GP (or out of hours GP if your normal surgery isn't open.)

It may seem a daft system, but there are good reasons why people can't self-refer to the Crisis Team. 

It's the GP's responsibility to make an initial assessment and decide what the appropriate management should be. That could be home care with supervision by a relative, medication, hospital admission (voluntary or involuntary) or referral to the Crisis Team for additional support while remaining in the community. It's not the job of the crisis team to make that initial decision on what is appropriate management (though they can make similar decisions in future once a patient has been assigned to them.) 

It may seem to the public to be a convoluted way of going about it, but it comes down to whose responsibility it is to assess and diagnose and for that the buck stops with the GP. (The responsibility 'buck stops here' issue is partly why doctors get paid huge sums and other, equally capable, members of the team get paid less. Such is the way of the western world.)

Once someone is under the care of the crisis team, then further 'crisis' incidents can be managed with a direct call to them. 

Hi Snowbear

Thank you very much for your message - it saves me much time, energy and stress making a formal complaint.

I can see the reasoning behind the system, and had that been explained to me on Friday night, I would have contacted the out of hours GP. A clear training need evidently exists.

As you correctly point out, the relative in question safely negotiating this episode is all that matters. It's just a terrible pity that they had to to so bereft of the NHS support for which they have paid taxes all their life.

[Taffy]

It is much more difficult out of hours which is usually when a crisis is more likely to occur I would think. Getting hold of an out of hours GP is like trying to catch a unicorn where I live.

The system should be easier, they quite often say to go to A&E but for someone in crisis that is less than ideal if not impossible.

I think a home visit by someone qualified should be standard.

[OceanDweller]

Just now, Taffy said:

It is much more difficult out of hours which is usually when a crisis is more likely to occur I would think. Getting hold of an out of hours GP is like trying to catch a unicorn where I live.

The system should be easier, they quite often say to go to A&E but for someone in crisis that is less than ideal if not impossible.

I think a home visit by someone qualified should be standard.

Thank you once again Taffy. I wholeheartedly agree. I'm trying not to become too agitated after the event. It's tricky!

[Angst]

Hi OceanDweller  Very informative and useful thread. Having made official complaints and having in the past to deal with official complaints,  I learnt that you need to include recommendations for future action in the context  of a particular person.I too would be upset in your position, but I would focus on the treatment of your relative in the future in the hands of the CMHT. 

[OceanDweller]

Hi Angst. Thank you very much for your message and for the advice you offer. I will be making certain that my family member receives the best possible care under the CMHT from this point onwards. Having been the recipient of substandard NHS mental health treatment previously, I will be particularly scrupulous (a gentle euphemism!) in my pursuit.

[Gary.p]

Hi oceandweller,

I was recently referred to the crisis team by the primary care team, but it does seem that some that work for the crisis team become " hardened " to the suffering of people with mental health needs. 

As your relative is not at their best, they will need someone to voice their concerns, because they are there one minute to support you, and literally gone the next.

I hope everything works out ok.

gary.

[OceanDweller]

2 minutes ago, Gary.p said:

Hi oceandweller,

I was recently referred to the crisis team by the primary care team, but it does seem that some that work for the crisis team become " hardened " to the suffering of people with mental health needs. 

As your relative is not at their best, they will need someone to voice their concerns, because they are there one minute to support you, and literally gone the next.

I hope everything works out ok.

gary.

Thank you very much Gary for sharing your experiences and for your well wishes. Very much appreciated.

[PhilM]

A slight tangent but similar(ish) I was "discharged" from the CMHT when I started seeing the therapist. We've been on this extended "break" for various reasons and he's told me that as he doesn't keep a list, if I want to continue the sessions I'm "owed" at some point, I have to go through the CMHT!

[OceanDweller]

1 hour ago, PhilM said:

A slight tangent but similar(ish) I was "discharged" from the CMHT when I started seeing the therapist. We've been on this extended "break" for various reasons and he's told me that as he doesn't keep a list, if I want to continue the sessions I'm "owed" at some point, I have to go through the CMHT!

Hi Phil. I hope you're well and thank you for your reply. I'm forcing myself not to think about NHS mental health provision today lest I fly into another rage!