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To get a psychiatric assessment

(41 Posts)
Sunflower49 Thu 02-Jan-14 04:03:50

I have a good friend I'm currently helping, who has mental health issues.

His GP have been particularly non supportive in the past.

Right now his (private)counselor plus a support group he goes to have both said he needs a psychiatric assessment and some medication.He'd need a referral from his GP for this obviously.

His GP have in the past refused medication and been particularly unhelpful.I have been to appointments with him before and they interrupt him, do not seem to listen to him, have lost information (for example he went for a blood test once and they accused him of not and said they didn't have his results 'cause it had never happened)!

He hasn't ever asked to be sent for psychiatric assessment before though.

Anyway I have a few questions for anybody more experienced with such issues than I am.

1)His boss has told me It's important for his work to be 'allowed' to give him support, for his mental illness to be diagnosed. Is it helpful or unhelpful to mention this in the GP appointment?

2)Would it 'look better' or 'look worse' if I go along to the appointment with him, note I have also expressed my dissatisfaction at their service before so they may be none too fond of me. Will it perhaps look as if the requests are not his choice if I go with him?If I don't, though I'm scared he'll clam up,not tell them the truth, accept things they say and not emphasize the importance of them listening to him.He's very passive with everyone and a definite pushover.

3)What sort of things are best for him to say to up the chances of them actually being helpful and listening to him?
Sorry for how long this is, and thank you.I'm quite frusrtated with this issue,and it is probably coming across in my post. smile

Sunflower49 Thu 23-Jan-14 09:33:06

Thank you with.

I'm okay-trying to be strong, I'm sentimental because I really want him to get better as I care about him a lot, but at the same time trying to be very rational-It's difficult!

SilverStars Wed 22-Jan-14 21:42:50

Hi - if he is still signed off, can he asked to be referred to his work's Occupational Health team/system? By the time that referral comes through he will have the official paperwork.

Work will be used to Dr's paperwork taking time as this is normal, and NHS dr's can take weeks I have found.

Glad sleep is better.

And hope you are ok too. I think it is great he has such a friend and advocate.

WithanAnotE Wed 22-Jan-14 20:58:15

For the purposes of the Equality Act, which would seem applicable here, a GP's diagnosis of a MH condition usually will suffice.

Even if a psychiatrist is involved it usually falls to the GP to provide the FIT note (unless you are in hospital) anyway.

Sunflower49 Wed 22-Jan-14 12:10:00

I am going to speak to his GP about getting a CPN definitely, thank you xx

I have a small issue today with his GP not writing his diagnosis on his sicknote, and his psychiatrist not being able to send a diagnosis document to his GP until next week-meaning his boss still does not have an official diagnosis to put on his file, in order to help him growl..... Will get there!

The medication doesn't seem to be working as yet but there's time. At least he is sleeping better, he was given sleeping pills and those are working. I am at his house now (It's a TIP!!!!!) awaiting a call back from the GP and trying to motivate myself to doing some sorting out for him-don't know where to begin!

livingzuid Sat 18-Jan-14 11:04:26

Hi if you ring your GP again and explain that he is in crisis they will do their best to get a speedy appointment. I got seen within 3 weeks as my GP pushed it.

If not, remember the GP is there to talk to and there may also be psychiatric nurse your partner can be referred to in the short term to have someone to talk to and see. Talk through options with your GP and explain your concerns before rushing off for very expensive private treatment as there could be other avenues available.

Sunflower49 Fri 17-Jan-14 19:54:11

Hi gimme, you're totally correct in all you say as it turns out, but I've already done that hurdle now! Thank you for the input all the same.
It sounds as if you know your stuff from experience and I suspect I shall totally be back to this thread with updates !
I did the right thing by going with him, and the right thing by explaining about his work smile

GimmeDaBoobehz Fri 17-Jan-14 19:02:16

1)His boss has told me It's important for his work to be 'allowed' to give him support, for his mental illness to be diagnosed. Is it helpful or unhelpful to mention this in the GP appointment?
It certainly wouldn't do any harm to mention this.

2)Would it 'look better' or 'look worse' if I go along to the appointment with him, note I have also expressed my dissatisfaction at their service before so they may be none too fond of me. Will it perhaps look as if the requests are not his choice if I go with him?If I don't, though I'm scared he'll clam up,not tell them the truth, accept things they say and not emphasize the importance of them listening to him.He's very passive with everyone and a definite pushover.
It might not necessarily look good but if they aren't taking your friend seriously and are making him out to be a liar it might be important to have someone else there. That way, nobody can claim it didn't happen because there is a witness. It doesn't matter how fond of you they are to be honest you are doing a good deed for your friend.

3)What sort of things are best for him to say to up the chances of them actually being helpful and listening to him?
To just be honest how he feels. Not to dumb it down and not to say 'it's all fine' because it obviously isn't sad

Sunflower49 Fri 17-Jan-14 18:51:11

Me too! He seems a lot better already!I think knowing that something is finally being done, and that the psychiatrist believes he can help , has had a huge effect on him.
His counsellor is only £30 an hour which is just as well as the GP told us that wanting an NHS counsellor would result in at least a six month wait. I had already taken him to an NHS counsellor at this point already, though.

Thank you all smile

SilverStars Thu 16-Jan-14 21:31:33

I am so glad you got that appointment. I agree the cost can be a lot less that people think and hopefully after a few appointments he will be stable on medication and not need to go so often. If people fund counselling privately the cost of seeing a psychiatrist is often a similar price - yes it would be ideal if NHS could see everyone within a week, but as we know that is not possible. If his private consultant writes to his gp the NHS should fund the medication. And if letters are sent to the GP then they should accept the private diagnosis, in case he needs more NHS support at a later date.

Yes A and E are often not seen as much use as they deal with accidents that need physical medical attention and emergencies. Often other NHS resources are less stressful and better resourced than A+E - the only time A+E is necessary is if OD/stitches needed etc. Any out of hours Gp can refer direct to a mental health crisis team and they can do everything at home, including mental health assessment. At A+E they have to wait for staff to get to A+E to do the same things. There are some that are well resourced for mental health issues, others less so. It may be worth asking the private psychiatrist what to do if a similar event happens - they will have good advice.

Sunflower49 Thu 16-Jan-14 14:40:28

Thank you for the support-the appointment went well. He has been given a prescription for BiPolar medication and also some sleeping pills. He will have an appointment once a month or so to monitor. The psychiatrist seemed very competent to me, really listened to us both.

He asked me if my friend used cannabis lol but I understand why they have to ask (he doesn't!) I'm now wondering if that was a factor in why the other one said residential?Ah well I'm overthinking.

The cost was very reasonable, about £170 for first session and then following are half price.

Iwas that's a sad thing to think about! Very glad you have good friends who support you though-as you say you are more than an illness, my friend is too.
He is going to pick up the meds today. I really hope they work!
LivingZuid thank you for your input, I'm so glad we got there in the end.

Silverstars thank you, it was pretty scary and also they weren't much use if I'm honest but he's okay now. I'll keep what you said in mind for future smile

Iwasinamandbunit Wed 15-Jan-14 10:28:06

Thanks for the update I hope this evenings appointment gets your friend on the road to the help he needs.

Thank you for your good wishes as well.

Having been around MH services for 20 years I have met lots of people with issues from mild to very severe the one thing that strikes me is how many are lonely because friends and family abandon them. Sometimes there can be real problems and you can see why people may have pulled away but it is very hurtful. I have had two very long term friends break their friendship with me after my last period of illness. I do still have three very good friends one gives her all a bit like you and she is amazing. She even had me as her bridesmaid because she sees through the bad times and sees me the person not just the illness.

livingzuid Wed 15-Jan-14 10:17:35

Sorry how did I miss your last post. I am so glad he finally got the referral. It's probably a scary place right now in his head but it will get better.

Psychiatric services in hospital are fantastic as are the crisis teams. There's lots of support with community teams as well.

livingzuid Wed 15-Jan-14 10:13:16

Hiya,

The GP should not be diagnosing any illness which requires a psychiatric assessment or medication to manage that. They should be referring straight onto a unit who can make the diagnosis and monitor medication.

I would recommend switching GPs and I got a very quick referral (within 3 weeks) when I was not well. Once the diagnosis the GP will be made aware and can support but the main care should come from the psychiatric unit.

These are serious medicines that are being dispensed and they are not prescribed lightly. They need regular monitoring for side effects too. I would be exceedingly concerned if a GP started dishing out the medication I'm on!

I hope they get their diagnosis soon. It is so tough to acknowledge at the time but once you have it and on proper medication and care it's life changing smile Good luck.

SilverStars Mon 13-Jan-14 23:02:14

Hi hope the Wed appointment is useful and it is a helpful paychiatrist ( and one that realises most people do not need to be residential!)

A and E can admit him to a general psychiatric ward if they think he is a risk to himself or others. If you are concerned at any time the easiest way to get crisis help is often through an out of hours gp appointment or at a walk in clinic ( not an a and e) as they can phone the crisis team who come out and visit in 24 hours, or less. That can be less traumatising than A and E. however if physical treatment is needed by emergency staff than obviously A and E is the place to go

Sunflower49 Mon 13-Jan-14 14:38:20

Hi all, firstly I'm really,really!Sorry that I didn't get back to the thread until now. Had an 'episode' with him being taken to A&E on Fri and then had no internet reception where I am until now.

(I'm not a fan of 'ruining' an apology with an excuse but that's how it was)!

Iwas that was a quote to see an actual psychiatrist. Thank you for the support,that's exactly how it was. He'd get so down and not know what was wrong with him, then he'd feel better and think everything was okay and so not want to do anything to find out, then he'd get down again....

Thanks Silverstars, I'm sorry I must have come across as depending and flippant, then.(Especially regarding serious physical illnesses such as cancer!) I've since spoken to the place who encouraged residential treatment and told them we cannot do that.

I spoke to them (the private one) again and they've agreed to see him for a psychiatric assesment on Wednesday. His GP referred. THANKYOU so much for responding to my thread and hope I've not come across as being a bit of a dragon! Stress and I do not mix well especially when related to somebody I care about.

He's pretty down at the moment and I know feeling that the situation is stressing me out won't help him so I try to not let it be known, and this thread has definitely helped with that.

I will update after the Wed appointment (It's an evening appointment).
Hope everyone had a great weekend and hope things go well for you too, Iwas.
xxx

SilverStars Fri 10-Jan-14 16:46:37

The referral times to MH are the same as to physical health teams - guidelines say you have to be seen in 18 weeks. They can put people under crisis teams obviously if needed before then, but that is a different team to the usual MH teams. The only difference is if someone is pregnant - they have a time of 4 weeks to assess, due to possible issues with the baby.

It used to be much longer than 18 weeks, but since Government put different rules in place no one has to wait more than 18 weeks. This does not mean a patient then gets immediate long term therapy, or inpatient treatment, or anything like that -there are long lists for such treatments, but it means they are assessed and put onto waiting lists for a place on a treatment program, given medication, may be referred to be under a CMHT, referred for CBT etc, or be under a psychiatrist for diagnosis or medication reviews.

How is your friend OP?

Iwasinamandbunit Fri 10-Jan-14 09:46:27

Thanks for your post silverstars I didn't know about specific referral times and have been a user of MH services for many years.

SilverStars Thu 09-Jan-14 19:44:30

Sorry should add the NHS should see everyone within 18 weeks of referral so it sounds like you got a quick temporary appointment to check he did not need sectioning or was at risk of hurting himself or others and he got triaged as needing MH treatment and the team that will do that can see him in 6-8 weeks. Whereas most people get referred by their gp and wait 6-12 weeks just for the initial assessment.

If it helps, even people with cancer diagnosis only have to be seen by 2 weeks.

When my baby son was very ill we were referred to an NHS paediatrician for diagnosis and treatment and had to wait 17 weeks for this. This was after several necessary trips to A and E ( sent by gp).

He can phone Samaritans anytime or text them to chat which can be useful. Also having a routine or a plan as to how to manage his time when signed off work can help, just little things. Getting up at a set time, good sleep hygiene, people to see etc may be helpful. Or is there any family that can visit?

SilverStars Thu 09-Jan-14 19:38:49

Hi I can assure you that 6-8 weeks on the NHS is very very quick, even if it does not feel like that. If you ask people on here most have to wait months just to see an NHS treatment and up to a year for counselling is not unusual. The NHS do not put people in hospital to monitor medication for MH diagnosis. This is very old practice! It can also make people feel "ill" if that makes sense. When diagnosed with many physical health issues people are not usually put into hospital to assess medication unless there is a clinical need.

No the gp would not diagnose serious mental health illnesses, just as they would not diagnose serious physical health issues usually.

Also I would say it is most unusual to have to be inpatient for private treatment, that just sounds like money making to me so I would certainly not want to see that private psychiatrist again!!! Certainly he would not be inpatient on the NHS just to diagnose and only inpatient if he is at risk of harming himself or others usually. When people are inpatient on NHS it is fairly basic, shared rooms, no talking treatment, see a dr for review nice a week. Better places may have OT's or recreational staff. But it certainly is not the rehab or priories you hear in the media. Some treatment centres are therapeutic but often with long waiting lists for places.

Personally I would find your own private psychiatrist for diagnosis elsewhere!! And go for a paid session, not a free one so get treated and medication request sent to gp ASAP as if bipolar medication is usual route. And then wait for NHS treatment to kick in.

But the NHS seem quite pro active where you are really, as 6 weeks is really short for any NHS treatment to start. Remember if he is actively suicidal and needs urgent treatment to get him to A and E or a dr straight away; this will not bump him up the list for mental health treatment long term but will ensure his safety until his local team can see him.

Iwasinamandbunit Thu 09-Jan-14 16:55:47

When you say 6 to 8 week treatment waiting list is this for some kind of talking therapy? Or for the actual initial assessment with the NHS.

If someone is suspected of having a life long enduring MH condition they do need to see a psychiatrist. I have appointments every 12 weeks with my consultant psychiatrist.

Unless someone is at risk of harming themselves or others then they are not treated an an in patient on the NHS. This also means taking new meds and waiting to see how they affect you at home. I have been an in patient previously when very unwell.

It is really great that your helping your friend, it sounds as if the poor guy just couldn't quite articulate what he needed to before. Also and I have been guilty of this when ill I have tended to minimise how I'm feeling and it is hard to find the words.

SnowyMouse Thu 09-Jan-14 15:17:17

The private psychiatrist should work with you as far as inpatient vs. outpatient goes. Good idea to try a different one and see what they say.
For diagnosis you need more than one episode - you can read the NICE guidelines Quick reference guide here, page 6 talks about referral.

Sunflower49 Thu 09-Jan-14 14:46:38

Okay the NHS said there's a 6-8 week waiting list to get treatment sad

I really don't think he can wait that long.

The private psychiatrist have said they'd need him as an inpatient to monitor the medication although they also have said in the past that he could be treated as an outpatient. Inpatient treatment ranges from £6,000 to £13,000...I'm not sure he can stretch to that (or would want to)!

So I'm kind of back to the drawing board-going to do what SS suggested and look again to the nearest larger city and see if I can find a different one and start again.

The GP did say Bi-Polar but I am assuming a GP is 'not allowed' to diagnose or medicate for that?
This is all so bloody complicated and stressful, It's making me really feel for people who are in his position (or worse!) and do not have anybody helping them at all sad

Sunflower49 Thu 09-Jan-14 02:37:54

Thanks Snowymouse x smile

I agree and thanks for the useful points, I'm hoping to go with him tomorrow actually, and no need for sorries, you've been very helpful!

I think It's Bipolar disorder to be honest, the private one we saw yesterday didn't actually diagnose as it was a free assessment, but he did say that's what he comes up with from the questions he asked and the discussion.

The GP said it would be very quick to see a psychiatrist, if this is unusual then hopefully it was because he thought 'Hang on I've been pretty crap here, let's sort this out!' lol.

I will ask for details on treatment. Thanks again all, It's very frustrating when you're watching someone you care about in this situation and nobody seems to know what to do, and I have got more help from Mumsnet than from anywhere else and believe me I've tried!

SilverStars Wed 08-Jan-14 20:48:11

That is great news. It is quite unusual to see an NHS psychiatrist so quickly. Can you get him to ask the psychiatrist how often the psych will see him, how long between appointments ( usually once diagnosed only see for medication reviews on NHS so 6 months or so is common and for 20 mins a time), so he gets an idea of treatment. Also usually see a consultant and their team in NHS so worth asking about this as not always the top person seen. Sorry just thinking about useful questions.

Hope between these 2 psych's he gets a diagnosis!!

Agree if do not have to pay even better.

Hope some medication is forthcoming too!!

SnowyMouse Wed 08-Jan-14 12:03:07

That sounds great, good luck.

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