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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

SilverStars Thu 02-Jan-14 10:41:14

If it was me I would go with him. He has the right to ask for a referral and it is up to the psychiatrist and mental health services to decide what to do with him at that level.

An alternative is for him to see a psychiatrist privately. A one off fee can be 150-200 pounds which may be worthwhile?

An official diagnosis means his work then has to make reasonable adaptations to support him etc, which without a diagnosis they do not have to do.

Sunflower49 Thu 02-Jan-14 11:36:23

Thank you Silver that's very useful info smile
If they don't support and I do recommend private, this is probably a silly question but is the outcome the same, as in their diagnosis means he will get the medication he needs and his work will have to make the adaptations?His boss is very supportive and wants to help, but as you say she has said for her to be allowed to give full support she needs a diagnosis.

NanaNina Thu 02-Jan-14 12:25:22

I really cannot understand why the GP is refusing medication, as almost always they are only too willing to prescribe, and ADs are very effective these days. I suggest he makes a double appointment with a different GP. and yes I think you should go along with him for moral support.

It is helpful if before the apt he makes a list (bullet points) of his symptoms and then it can either be handed to the GP or used as an aide memoir during the appointment. I don't see any reason why you should be overly concerned about the "best things to say" - the GP needs to know the symptoms so he/she can make a diagnosis. GPs are very well paid out of our taxes and we are the service users, so you have every right to expect a good service, and should not feel cowed by the medics.

As far as a psychiatric assessment is concerned, this is a matter for the GP and statistically 1 in 10 people consulting their GP on a mental health issue (one third of all appts are mental health related) will be referred to a psychiatrist. This is done on the basis of clinical need as it would be with a physical illness. GP is as I'm sure you know, primary care and usually patients are treated initially by their GP and referred on to the relevant consultant if the GP thinks it is necessary, and then you move to secondary care.

I think you need to start with the GP - a different one and take the list with you. I am assuming your friend has depression but you don't mention his symptoms but whatever it is he has the right to be treated properly both clinically and courteously as a patient.

Sunflower49 Thu 02-Jan-14 14:16:24

Thank you NanaNina. smile

I will go with him..I do want to was just scared in case I made the situation worse. I'm very forthright and won't accept rudeness and I know this can stress him out (for example last time they began talking over me and I said ' Please, you asked me a question, let me anwer it').

I'm not nasty, just he is so passive and sees me not letting them fob us off, as too much-also because of my complaining I figured they may think I'm bullying him into asking for things-the truth is he's so down he finds it difficult to accept he needs help , and they've made him feel further down for refusing it-he sees it as he's set up to fail so why bother.

They've been very difficult.One reason for the refusal of medication was that he mentioned a few meds that in the past have worked for him, and they told him that they are no longer allowed to prescribe these (this is true I looked it up,they're down as 'controlled drugs').They offered no alternative and suggested he joined a support group (which he has).

However he has asked them since and they instead suggested he makes another appointment to talk to them about stress.

They suggested this to me when I went to collect his sicknote, and I had a bit of a go at them as at the time he was feeling totally failed by them as they'd been so little help,he was too stressed to go into the place!

I told them that they were currently a cause of his stress but I would let him know and he would call if he felt that appropriate (he didn't, he said if he wasn't feeling so down he would find it amusing that they suggested that after seeing him break down when they refused to give help).

Bulletpoints yes!-I have already given him a small list of things I think are important to mention but not his defined symptoms, I will add that and talk to him to make sure he has it clear. Don't get me started on the taxes thing!I respect (good!) medics with all my head and heart but I have used that line when he's in the past defended them!He defends everyone, he's so nice to everybody apart from himself.

He does have depression, also swings of psychosis ,talks to himself and shouts and gets angry although never with other people only himself. Doesn't sleep for days...Repeats himself a lot... I want to help as he helped me through a lot of my problems a while back and he's very dear to me, hence why this situation is driving me nuts.

I do feel let down by this GP but luckily,last time he required a sicknote a new doctor at the same practice called him to discuss it and he had a nice talk with him and he says he would feel confident listening to that particular doctor. Fingers crossed!
And thanks again smile

SilverStars Thu 02-Jan-14 16:38:19

Yes if he gets a diagnosis from a private psychiatrist and that psychiatrist writes to his gp stating diagnosis and medication recommended the gp then is asked to prescribe!!

A diagnosis stands. If the gp disagrees with a private diagnosis it is up to them to fund a second opinion on the NHS. I just thought if he was going private for counselling a one off fee, for an hour appointment with a private psychiatrist may be an option. You do not get as long with an NHS dr and it may suit your friend to be comfortable enough to speak and get things sorted quicker?

Sunflower49 Thu 02-Jan-14 17:08:11

It's a very good option and I feel ashamed I didn't think of it before!
I am going to ask him what he thinks, and then try to find a private psychiatrist smile
He pays weekly to see a counsellor at the moment so I don't see it being a problem if he likes the idea.
Thank you, have some thanks SS and NN smile thanks

SilverStars Thu 02-Jan-14 23:09:02

The counsellor may be able to recommend a private psychiatrist or direct your friend to a few. Private hospitals usually have private psychiatrists as well if that helps.

Sunflower49 Thu 02-Jan-14 23:12:27

Thank you-I'm a googling right now!

Sunflower49 Sat 04-Jan-14 19:16:25

Another question -sorry!
IF they do refuse a referral, what can we say?Can I say we will go to a governing body or something?Is it the Care Quality Commision?

I ask because a)we haven't been able to get an appointment. I and he both began telephoning to GP (separately )at quarter to 8 (they open at quarter to nine) couldn't get through, their automated system not working and when we finally got through (well he did) was told they were full. We have to try again on Monday.
And b), I am struggling to find a local private psychiatrist sad

a) isn't giving me much faith in them so I'm worried again.

SilverStars Sun 05-Jan-14 00:38:17

It will be difficult to get a gp appointment this past week or even next week as most would be closed due to bank holidays and therefore will have lots of people wanting one. Also do not know what the gp system there is like but if urgent illness we get seen straight away or if not urgent usually a 2 week wait. Especially in winter months!! So although frustrating can understand it will be full today. Worth a try for Monday even if have to wait to get one!!

It is the CQC yes that all gp's are under now.

For private it depends where you live. Are you near any major cities? If so they will have private hospitals. I just found my nearest Nuffield/ Bupa hospital and clicked on their find a consultant list and found a choice of 4 psychiatrists to choose from. Could you do this? Even an hours drive for an appointment should be ok?

RubyRR Sun 05-Jan-14 20:47:27

Have you tried looking at a local private hospital, usually they have visiting psychiatrists a few days a week for appointments.

Sunflower49 Mon 06-Jan-14 08:46:09

Thanks Silverstars-I finally managed to get him an appointment today although not with the GP he wanted to see as he's off until Thursday.

He needs a sicknote for work so we really cannot wait that long, plus who's to say we'll be able to get an appointment on Thursday sad

The receptionist wasn't very helpful when I tried to explain that their automated system wasn't working, spoke over me (again asked me a question and interrupted me when I began answering it.

I know this GP we're seeing today was the one who refused the meds last time sad

Anyway, my plan is to go in with him, say we need a sicknote and a referral.

I plan to say that his counselor and support group all agree that he needs to see a psychiatrist.

And I plan to get him to reiterate his symptoms.

Please wish me luck, I'm actually feeling very anxious myself, now! This'll be me as well if this carries on lol.

I'm looking at our nearest large city for private hospitals and psychiatrists now just in case. Thank you again all, for your help.xx

Sunflower49 Mon 06-Jan-14 08:53:51

Also he's so stressed out with this that he's currently crying and unable to string a sentence together.
I think I will have to do all the talking, whether that is going to help us at the GP or not...

SilverStars Tue 07-Jan-14 13:10:46

How did it go?

Any luck with finding nearest private hospital and names of private psychiatrists working there?

Sunflower49 Wed 08-Jan-14 09:46:38

It worked!

The GP was sympathetic, listened to us both, referred us for both private and NHS psychiatrists and talked us through some other services.
I'm not sure if one aspect of our behavior in this appointment worked, or if the GP was feeling more helpful this day, or if something else-but things went well!

Thank you so much, everybody who has replied. I'm sure what I have learned here played a large part.

We've seen a private psychiatrist and will see the NHS one tomorrow, to decide which the best option-obviously if the NHS one seems good it would be better, he has a good job but nobody likes to spend £ if they don't need to.

There was a lot of apologies from the GP,and he asked me to detail everything that had gone wrong to enable him to look into it.
Feeling much better now, and more importantly, so is my friend. thanksthanks smile

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

That sounds great, good luck.

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!!

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!

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

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.

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.

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.

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?

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 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?

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 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

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.

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.

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.

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

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 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

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 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

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 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!

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.

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.

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!

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