NHS mental health team referral rejected - can anyone shed some light?

This reflects my experience - although mine are not as extreme as yours. It feels especially cruel given the nature of illness periods like hypomania - when an external steady scaffold is just what is needed.

Cmhts are quite patchy

I was once referred to cmht whilst in a hypomanic episode. The psychiatrist adjusted my meds saying "you work full time you don't meet our criteria" and discharged me without waiting to see if the dose change was going to help.

A few years later under the same cmht I couldn't be discharged from hospital until I had a cpn. They assigned me on but he saw me once whilst I was on leave and then never came back. A few months later a second cpn came twice. The first time she said she wasn't going to leave, 2 weeks later she announced that she was leaving and someone else would be in touch.... They didn't. I went from the perinatal team with weekly cc support to hospital for 10 weeks to absolutely no support and didn't get a psychiatrist review for 6 months.

I've since moved, next cmht accepted referral. Another cpn came once, promised to not disappear like previous cpn. This was September 2022 and I've not seen him since! Although I was technically under the cmht I didn't have any appointments with them for nearly year until I approached my GP and TTC and they requested a medication review.

My area is in the process of bringing all patients taking lithium or valproate back into secondary care with a prescribing nurse.

Have you seen if you’re eligible for an S117 entitlement? I don’t know how strict the criteria is but I thought this was for people who need the type of support provided that you’re indicating you don’t currently have.

My Mum also has monthly catch ups with her nominated mental health nurse.

I usually hide the mental heath topic to stop myself being tempted to post but somehow it’s unhidden itself in an update or something.

Sorry. It was less a typo (although I don’t think I added a space) and more using a technical term
Psychoeducation refers to ‘providing clear information to patients and families about mental health conditions in order to improve understanding, support, and treatment outcomes.’

I honestly had no intention to upset anyone and I am sorry that I did. I just wanted to be realistic about expectations of the NHS

Well I'm.hoping anyway.

I think that poster meant psych and got an autocorrect

No need to be quite so unpleasant. I don’t have any friends or family

I have to agree with this.

It will never in a blue moon be possible to see a psychiatrist every 2-3 weeks on the NHS for an unlimited time period.

I struggle to see that this level of highly skilled input is actually required by anyone. Could your friends and family not tell you if you had lost insight and were relapsing given appropriate psycho education and would that not be more adaptive than being dependent on one professional who could retire or move on?

(Of course you are at liberty to do as you please with your own money)

It is a dire situation OP. I lost my private medical insurance recently but I pay myself to carry on seeing my private psychiatrist every two or three weeks. It is really reassuring to know that he is keeping an eye on me and he can let me know when I am losing insight into my condition. In an ideal world that level of support should be provided by the NHS too. I hope you can get a referral arranged.

This fits with what happened initially for me but my consultant made it sound like everyone on lithium was back having annual reviews with consultant. Maybe it is just me or individual areas make different decisions. Resources are finite for sure. I wouldn’t know I guess. My GP also messed up completing my DVLA form and my license got revoked until my consultant completed a second form so I think that got into the mix. I am lucky I have a lovely GP surgery and a lovely CMHT too. It’s still a scary situation to be in though at times and the system doesn’t always respect that.

My mother is on clozapine - which has been a wonder drug for her and she’s been on it since it was first licensed in the UK because I remember her having to wait do the licensing process to complete to start it. Her mental health went in the 1980s and that was not a great time to be mentally unwell. I have a lot of memories of medical people screaming at her.

GP can also ask the consultant for advice & guidance on meds changes without them having to make a referral.

We discharge people who are stable on lithium and antipsychotics to the GP in our area. The only people who stay under 2nd care are on clozapine or have a S117 entitlement. Less routine review slots leads to more available slots to respond to urgent referrals which can be seen in 5 working days. People should also have done work on avoiding triggers, staying well and have an early warning signs/ relapse prevention document. Then when warning signs occur an early re referral can be made.

I would expect you to have regular reviews and stay under CMHT care like you have been then, based on my experience. Your and my conditions require drugs that GPs don’t have detailed knowledge of prescribing. GPs I think are more used to dealing with unipolar depression and prescribing drugs for depression, anxiety etc. But I don’t know really - my experience is limited to my condition and my part of the country.

I take lithium among others and I have schitzoaffective

I wonder (I don’t know) if your diagnosis and meds are relevant here. I appreciate you might not wish to say.

For example, I was discharged from CMHT with a bipolar diagnosis after an episode of hypomania and being sectioned in hospital for a month. However my GP immediately requested that I be permanently under the CMHT because lithium is a specialist drug. I now have an annual review and open door access to CMHT if I feel I’m having an episode.

As your GP is able to continue the drug regime that works for you currently. There isn’t anything for CMHT to currently do. If you need to know where to if you get unwell, I can certainly understand that. I would assume it would be 111 option 2 or via your GP. During my last episode, calling the crisis team wasn’t as successful as calling my GP and asking them to intercede on my behalf. Now my condition is known and I’m not a danger to myself or others, my urgent need for a medication review didn’t feel urgent to them until my GP spoke on my behalf doctor to doctor. I don’t trust the system to work now. I have a good consultant but people can change jobs anytime .

It might be due to the specific meds you are on as some ‘red drugs’ and some ‘amber drugs’ GP’s cannot prescribe without specialist monitoring.

Without knowing your history and the meds its difficult to say ( nurse who works in Psychiatry/ spent many years in CMHT and access / triage services) but from what you have said its likely because you are currently stable.

Services now work on an ‘episode of care’ type model, so if you start to relapse or if for some reason you can longer take your current medication regime, then there is a piece of work for services to do there.

They won’t accept or keep people on for monitoring type work, even when there is a significant risk of relapse as they would be literally inundated.

I suggest making a crisis/ contingency type plan and sharing that with your GP and any trusted people in your life. Then alerting your GP at first sign of relapse whereby they can re- refer you.

If you struggle with suicidal ideation then the ‘Stay alive’ app is good and endorsed by the NHS and you can populate it in advance of a crisis.

That's awful. Could you see a different GP at the practice? I hope you find some help x

There has not been any sections.

In some areas if you have a s117 entitlement they have to keep you on for a 6 monthly review. It might be that.

I have been stable for four years but still see psychiatrist at NHS every six months. I don’t understand why as I have always been fine and taking my medication.

Surely I could have at least been put on a waiting list?

I guess that is the crux of it for me. A waiting list for what, exactly? It sounds like you are happy with your current treatment and want to be sure that the NHS is there for you if/when you become acutely ill again as a result of your longstanding illness.

Would it be right to say that what you need, essentially, is reassurance that urgent care will be there when you need it? Insofar as adequate urgent care is actually available on the NHS, it should be available to you immediately should you become severely unwell. It isn't a question of getting on to a waiting list first.

Or is the deterioration that you fear more gradual, not quite sudden and catastrophic enough to need an emergency intervention? I can see that you might then want to be already on someone's books, as it were.

I guess a key question would be: how would this have been managed if you had been an NHS patient all along? Depending on your condition, it is entirely possible that you would have been discharged from specialist NHS care once the medication had been sorted out well enough to keep you stable. And instructed to contact your GP if things started to go downhill. So you might not be any worse off as a result of having used private care in the past.

If your condition involves the possibility that you might get significantly worse, but not bad enough for emergency intervention, I'm sure that the GP could make an urgent referral, which might make more sense than the 'preventative' referral that you expected