Health Anxiety clogging up A&E

[Influencerofcrap]

Im really pleased that finally someone within the NHS has come out and said this.

Having been treated myself in A&E, in the corridor (outside triage) due to lack of cubicles, I was genuinely shocked at the amount of patients that attended who shouldn’t have been there. I’m not talking about those that were genuinely ill and couldn’t see the GP and had no other choice but the ones that were clearly anxious about their health and symptoms that didn’t warrant an A&E visit. They were all sent on their way but it still was time that was taken away from those patients that genuinely needed help. I wonder what the answer is to this, because something has to change.

Health anxiety not emergencies clogging-up A&E

I also work for a MHT. I don’t think there has been a specific rise in demand for treatment for health anxiety….social anxiety following lockdown yes.

I bet you are also aware of the cost of DNAs and Cancellations - it is extremely frustrating as that group of persistent revolving door individuals block that appointment slot for those waiting who are willing to attend and engage.

Its a constant challenge to manage resource and meet targets - which also change

God I wish a brief course in generic CBT administered by poorly trained staff most often not even face to face wasn’t pushed as the cure all. MH is complex and CBT does not work for everybody and far less likely when it’s a cattle market course run by somebody with relatively little expertise.

Access to individualised care administered by well trained and highly qualified and experienced professionals is what is needed and what most people seeking help are not getting,

Health anxiety or a bad cold - go to your pharmacy. They give a lot of health info and advice and can give out prescription meds under the Pharmacy 1st scheme - if clinically appropriate. Something more serious GP. There's a lot of steps you can take before A&E.

Would also like to add that many people struggling with MH now have been let down massively the past few years and things that might have been helped by the right treatment a long time ago have been left to fester into more problematic conditions.

Also as an aside often people
struggling the most are the most vulnerable who will have been let down the most with the least support and more additional needs such as ND.

So let’s not get into patient blaming as an excuse for the absolute shite that has been the MH sector the past few years.

I never get why people with a sore throat or minor ailment want to go to A&E and I have health anxiety myself (mild, but still) as the wait is horrific. Last time I was there in Nov 23 (after losing consciousness at home) I waited all night on a hard plastic chair, still having what I now know were focal aware seizures. DH had to leave as his dodgy back couldn't bear sitting in the chair for so long, luckily I had come out of the seizure pattern and was feeling a bit better by then.
My GP isn't even that bad - it operates a e-consult system although you can book direct online as well through the NHS App. Routine appts are usually two weeks away, but I have had a call back on the day and been triaged as more urgent as well.
We are also v lucky to have a minor injuries/walk-in 5 mins away. Have used this so many times over the years for me and the kids when we've had injuries that don't warrant A&E, but they are not in every area. DS had to go to one a couple of weeks ago in his uni city - he had a very septic finger and couldn't get a GP appt for a few days. He asked me if he should go to A&E when we spoke about 8pm that night and I said not unless you want to sit there all night and get no sleep - so we looked up the nearest minor injuries - I advised him to go first thing in the morning (I'd pay for the Uber - £15) and he got it lanced. He also attened the GP surgery a few days later as it was still a bit raw and horrible - the nurse he saw said he did the right thing going to minor injuries as they don't lance things at the surgery and gave him some dressings.However, if you don't have a minor injuries near enough you can see why people would go to A&E for something like this (not really an emergency but if GPs don't perform this v simple procedure what other option do you have?). And much preferable to antibiotics which shouldn't be used if at all possible.
So my take on this is that A&E would be the last place I'd go even with my health anxiety - and health anxiety is also a mental health condition worthy of treatment (which I have had).
GPs need to be much better funded and we should be able to access a lot more at the primary level like minor procedures.

You are entitled to one to one care. The guidelines state up to 20 sessions but this is not always required. I’d suggest requesting this and refer to the NICE guidelines. You should be seen by a high intensity practitioner for personlised care.

However, you are right CBT does not work for everyone. It does require adequate engagement by individuals who have self awareness and insight. It also is more effective if it is at the right time and they are open to change. There are individuals who turn up to therapy and have no motivation or intention to get address their issue.

I remember the days when a GP would stitch a bad cut. I took a flap of skin off my knee aged 8 and the local GP thoroughly cleaned the gravel out, put in a couple of stitches and bandaged it up. He took them out about a week later. He spent no more than 15 minutes in total.

Nowadays that would be: triage 5 to 10 minutes, XRay 10 minutes, stitches in, probably with local about 20 minutes, trip to practice nurse to have the stitches out 10 minutes.

And we wonder where all the money goes. There are just too many moving parts nowadays.

One to one care by somebody poorly trained and with not enough experience of wider MH conditions pushing CBT which many people can’t access and it’s then subsequently dressed up as their fault is completely shite.CBT done by those not experienced or qualified enough on people it’s not appropriate for can be quite damaging so shoe horning anybody asking for help into this which is the current practise is ridiculous .Accessing CMHT which is dire and just one long wait list with yet more poorly trained staff entitled “support workers” who act as gate keepers from to the highly trained professionals anyway is almost impossible.

So struggling people turn up at A&E. Provide a better MH system and things might improve.

Incidentally, I've been on hold since 8am to GP for my DC. When I get through, I may get an appointment or be told to phone and try again the next day ad finitum.

Cbt didn't treat my health anxiety at all, no matter what the NICE guidelines say. This blinkered approach really doesn't help. Its not as easy as that. I just wish it was.

Again not how health anxiety works would you tell someone with a suspected heart attack or suspected brain anuerysm to go to a pharmacist because that's exactly what someone with health anxiety truly believes when they have chest pain or a head ache. People with anxiety aren't going to a&e because of a cold or a cut finger there going because they truly believe their dying. This is also where 111 doesn't help as if you mention the word chest pain there sending an ambulance

Didn't help me at all either the only thing that has helped me over time is understanding drs who have listened to me and took time explaining things properly. Plus a dr hasn't tried to kill me for a few months so that has helped

Actually CBT training is rigorous and is a minimum requirement for talking therapies.

If you were unhappy with your one to one care you can request a change in therapist or further assessment. I think it’s not helpful to view all MHCP this way as give already decided the treatment/therapist won’t be able to help you. I’d encourage you to request one to one and explain your reservations so this can be a consideration in your treatment.

Support workers/CPNs will not be trained to the same breadth and depth as a CBT therapist. They would not be able to register with the professional body for example, even though they may have had some CBT training. Unless you have a severe lifelong diagnosis you are not likely to receive therapy under a secondary care team such as CMHT.

I was admitted to hospital last November. I went to my GP first who sent me to A&E. I was seen immediately as I was extremely unwell. While waiting for blood tests and scans I was sitting with four other people who were all waiting to be seen by doctors. Four of them had overnight bags with them and came prepared with food, phone chargers, pyjamas etc. All four of them talking about their health and how they had only been in A&E a few weeks ago. They were practically excited at the thought of being admitted. I was obviously to unwell to even talk so just listened to the conversations. All four where sent home. One woman actually asked could she stay a bit longer to finish her tea as she was enjoying it. Absolutely nothing wrong with them.

I was appalled at the time wasting and taking up valuable resources that genuinely ill people need.

Post viral syndrome, always been a thing.

Yeah, I’ve had it before.

But never bedbound for 18 months.

CBT is not effective for everyone

CBT maybe the treatment/intervention but is not ‘done to you’ it requires individuals to work collaboratively and make necessary changes. There is no magic advice or anything done to you by the therapist.

It amazes me people are happy label their issue as health anxiety but then pursue medical interventions from physical health services. If it’s a form of anxiety you’ve identified then address it as anxiety.

Pathological anxiety (of any type) is based on anticipated feared outcomes that are not based on accurate factual information. This is a pattern of responses over time that are unfounded.

@MooseAndSquirrelLoveFlannel - you think every virus has the exact same post viral set of symptoms?

@ArseInTheCoOpWindow 💐

'Do you think the walking anxious as you name them want to be feeling like that???Anxiety is still a illness yes a mental health illness but still a illness.'

Severe anxiety is of course a recognised mental problem and people will be on meds and have reviews.

Thing is, anxiety like depression has become such an overused phrase that everyone diagnoses themselves when actually worrying about your health is normal. Fixating on it to the point you go to A&E every week with constipation or a cough is not. It is obviously hard for hcps to separate the worried well from those who are ill and that is why A&E has 12hrs waits.

Honestly, watch any programme like GPs behind closed doors or A&E 24/7 and it is staggering what people see HCPs for. One bloke last night saw a gp because his toenail was hanging off and what should he do. Another lady called an ambulance because it stung when she passed urine .

Where did I say they have the same symptoms?.

I had PVS after glandular fever when I was 19, spent 2 years bedbound and a further 18 month on graduated return to work..

Post viral has always been a thing, pretending it doesn't exist and putting words in my mouth is very disingenuous of you.

And the point here is, the Daily Death Show increased people's anxiety and covid WAS just a bad cold for MOST people..

But ignoring that fact for your own attempt to argue and prop up your agenda is fine.....you do you.

Lack of access to GPs and lack of faith in the ability of the GP to correctly diagnose is a huge part of the problem.
Out of hours support is another issue - we used to have an out of hours GP service which was great, but now it's ring 111 or go directly to A&E.
I cannot use 111 after they missed the fact I had sepsis and how they once made me wait 14 hours for a call back with a sick child, so if there are issues out of hours now I go directly to A&E. There is absolutely no other option! (Note: only for serious issues, not colds etc.)

Seeking constant reassurance from others including HCP is a common and predictable ‘safety behaviour’ - you are relieved and reassured by the GP initially, until the next time. Which maintains the cycle of anxiety.

If you recognise and label it as health anxiety then address the anxiety.

Despite living in a very large town we’ve only just got a small injuries unit back again which has frankly been ridiculous. I’ve had to drive miles away before with DC.
DH needed a tetanus recently and he was able to go there and be out fast without sitting in A&E for hours.

@Shakeyourbaublesandsmile I just don't think you understand how debilitating it is?

I've had a headache everyday for the last seven years. I've constantly been told it's all in my head and no further investigations done, it becomes harder to rationalise