CMHT discharge

[mypip]

I'd like any good sense and opinions. I'm being discharged from the cmht back to the GP, I hear stories that if you are stable- ish they will do that despite still being unwell, unstable and so on, and it's the manager not the psychiatrist. I've been 2/3 years with them, I'm a 59 y male.

[straightouttacompton]

It's rare for someone to be under a CMHT for 2-3 years these days.

That suggests that their intervention isn't helping much any way so they may feel that realistically, they have nothing left to offer which could be useful that couldn't be provided by the GP.

[mypip]

Thankyou, straightouttacomptom, the regular appointments are helpful, and I'd like at least reviews of my medication I think.

[KeemaNaanAndCurryOn]

Lots of people are being discharged back to GP now as there's so little funding in MH that they're only keeping on the cases they're sure couldn't cope without secondary care.

I know a lot of people who are feeling very unsettled about being discharged, but having spoken to senior managers in my trust at least, those who are discharged can be fast-tracked back into services of they deteriorate to the point where the GP can't help.

Ask at your GP surgery if they have someone with a MH specialism. You'll find that most GPs will offer that and regular reviews with people who were previously under the CMHT.

[mypip]

my GP said he can offer regular reviews.

[erinaceus]

It is good that your GP has agreed to offer regular reviews. I agree with PP, if you are not under CMHT then finding out whether a GP at your surgery has a particular interest in mental health and arranging your reviews with that Doctor is one way to take a bit of control of the situation. Perhaps arrange a double appointment for the first review so that you can have a bit of time to explain your concerns, and work out under what circumstances it would be most appropriate that you be referred back to the CMHT, and agree that and get it written into your notes? Of course referral criteria may change in the future, as may you, but this is something else you could review over time. Maybe you have already thought of all of this.

Are you in touch with other sources of support, such as voluntary organisations? I have found, for want of a better way of putting it, "service-user-led" support invaluable. YMMV of course and it depends on what is available in your area as well. Sometimes it takes a bit of digging to find what works for you.

[fizzychips]

I've been under my CMHT for 6 years. I'm quite insistent on maintaining the relationship with them, as a consultant psych is far better than a GP for things like supporting PIP/ESA applications, and other letters to provide evidence of MH problems. In appointments I always emphasise the severity of my symptoms, play down signs of improvement, and show interest in the different interventions they have on offer (currently being assessed for a therapy I've not tried before, but I've had different types over the years).

[heknowsmysinsheseesmysoul]

Please don't take the above advice to downplay improvement to access a Psychiatrist to write letters for you to access benefits.

That is not what a CMHT is for.

[mrgrouper]

I am fighting at the moment to get more support from CMHT. I bitterly regret allowing my psych to pressure me into agreeing to get signed off in 2013. Although I suspect if I had not agreed I would have been booted off anyhow.

[mrgrouper]

actually I think fizzychips 's post summarises quite neatly how mental health services is now. Due to PIP one has to be put through degrading assessments to prove illness. I do not blame her to be honest.

[heknowsmysinsheseesmysoul]

People in acute MH crisis can't access the help they need because of lack of resources. If a place on a CMHT caseload is being blocked because someone is downplaying improvement so they can access PIP or other benefits then I think that's an inappropriate use of a stretched service.

It impacts on other people who clearly need the service more. The inadequacies and shittiness of the benefits system should not be an excuse for someone to take up a valuable service they don't really need.

[mrgrouper]

I bet there are a lot doing it heknows I am not saying it is right, I am doing my best to get an emergency appointment atm

[erinaceus]

In appointments I always...play down signs of improvement...

From a clinical perspective this sounds dangerous to me.

I say this specifically because treatment carries risks, and if you report your symptoms inaccurately, you risk being over- or under-treated.

If you feel concerned about the level of support you will receive when you transition from CMHT to GP care, discuss this with your treatment team, rather than trying to control the level of support you get by selectively sharing, withholding, exaggerating or playing down your symptoms.

[mrgrouper]

heknows please do not blame fizzychips for delays in emergency referrals. It is the government who are at fault. They created this system.

[Rinoachicken]

fizzychips but if you have no intention of positively working with therapeutic interventions because to do so would see you be discharged, what's the point in trying all these different types of therapy.

It's not a pick and mix shop, it's a service for very vulnerable people who often to wait months if not years for a therapy space you fancy trying out because it's one you haven't tried before??!!

[mrgrouper]

I pay 75 an hour for a private psychologist because I cannot access it on the NHS. Wish I could pick and mix psychological therapies for free

[Rinoachicken]

mrgrouper

My point exactly. I have had to do the same in the past.

[heknowsmysinsheseesmysoul]

mr - I'm not blaming OP for all the problems but having full recovery team caseloads does impact on cases from other teams (Crisis, EI etc) being handed over so it causes a bottle- neck where more and more cases are unable to be handed over to the appropriate services which impacts on other teams.

And MH services are underfunded. And the reasons for this are multi - factorial but I was around for the dismantling of many services in years gone by and there were a hell of a lot of people who had been on MH caseloads for years that simply did not need to be. So the government threw the baby out with the bathwater and went to the other extreme and now people that 20 years ago would have lengthy informal hospital admissions on acute Psychiatric wards and have a CPN for years wouldn't even be considered severe enough to be taken on to secondary MH caseloads anymore.

The days of having an episode of mental illness and having a CPN pop round week after week after you've stabilised to have a chat about how you're feeling and help you out with stuff are well and truly over.

[mypip]

may I ask what when you are discharged but though coping after a fashion are still unstable, weak and vulnerable? obvious to me and my loved ones.

[heknowsmysinsheseesmysoul]

Thresholds are high. I'm not saying that's right but it's the way things are now. And the opinion of you and your loved ones as to what constitutes 'unstable, weak and vulnerable' are probably very different to those of experienced MH professionals.

As an example - there was a post on here a while ago by a poster who was upset that she felt she was severely depressed but the CPN didn't agree. The poster was maintaining her personal hygiene, looking after the housework but cried a lot and had dark thoughts at times.

In the framework of her experience - that is severe depression, the worst she's ever felt. To MH services, severe depression would often include self - neglect and neglect of usual duties, psychomotor retardation, anhedonia, blunting of affect etc.etc.

[mrgrouper]

heknows I refer to the thresholds as "homicidal or suicidal". Anything less, they are not interested.

[mypip]

I may write to the cmht, a polite note.

[erinaceus]

Anything less, they are not interested.

I can see where you are coming from, to be honest. However, I think it is more accurate to say that anything less and the NHS not adequately funded, not not interested. I also found it much easier if I stopped thinking of "us and them" but just "me" and "what is available", if that makes sense? It is hard though.

[erinaceus]

mypip if you are able to be as clear as you can be about what your concerns are and what you think the risks of your being discharged are, I think that is an appropriate thing to do. You may be able to come to an agreement where you feel more supported, or a slower transition away from CMHT, or a handover meeting between CMHT and your GP, or something like that.

Good luck!

[mypip]

my concerns include: agoraphobia, crisis points, caring for mum and the house, eating properly, drug side effects, mental disorientation and more; cmht suggested social care who assessed me with ineligible needs and signposted me to advocacy, voluntary work etc groups, no support worker, despite the agoraphobia etc.

[mypip]

ill see if I can write something.