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

Im just offering a clinical view of what being in crisis means. The service I work for will not offer treatment or continue treatment if someone is in crisis according tho the definition we use above.

I think it is inaccurate to have the word crisis in their to be honest.

We would treat most things on that list but not deem them to be in crisis. If I tried to refer them for being in crisis for urgent support it would be a flat no.

I think it’s the use the word crisis that means different things in clinical conversation in MH services to what is stated in that website.

It irks me as this sort of thing as on the main NHS website CBT is stated as a treatment for all sorts but it is not always offered by each trust then you have people arguing they should have a service.

@Shakeyourbaublesandsmile

Probably another thread, but doesn't this just show how ludicrously we treat mental health?

In MH services when someone refers to being in crises they need urgent care to reduce the risk of them hurting themselves or others. It means the are at imminent risk for being suicidal or violent towards others.

Ok, so... if you're about to kill yourself you count as "in crisis" and are allowed help. Except... if you've decided to end it right now, you're not going to ask for help, are you? You're past that stage.

It's the stage where you're having bad thoughts, dark thoughts, thinking of suicide as an option, that you'd seek mental health help as an alternative.

So we've got a situation whereby the people entitled to timely help are the ones who are too far gone to ask for it, whilst those who do recognise they're going down a dark path are dismissed as "not in crisis (yet)".

A really grim, dark catch-22.

A friend of mine killed herself for this exact reason. The act of asking for help meant she was seen as "not immediately suicidal". In the end she gave up asking.

It's bonkers, and dangerous.

I'm not sure where you're getting your information from re. people refusing to speak to emergency doctor, or the implication that people are just saying they're suicidal without really meaning it. I'm sure it happens occasionally, but am concerned you're dismissing people as "not really suicidal" when they are, they're just still at the stage where they can just about believe someone might be able to help. It doesn't help that mental health staff appear to take this outlook too.

The equivalent in physical health to the way mental health services are run would be if there was low-level care for coughs and colds and stuff (equivalent to self-referral primary care mental health services), and an intensive care department for if you're at death's door, and nothing inbetween. No way for a GP to refer you on for tests or operations or to a consultant, until whatever's wrong is about to kill you.

The whole system needs an overhaul. The NHS is very reactive rather than proactive and that needs to change.

Our GP has an e consult system that I have used to get an appointment for myself. I have had a gynae issue but the first thing that comes up is have you seen a pharmacist for support and if not they should be a first point of call. I'm a pharmacist I'm aware that gynaecology issues such as mine are beyond my professional remit and I need to be seen by a Dr or nurse. Not everyone understands the remit of our profession though and will turn up asking for help because that's what they were told by either a receptionist or an e consult system. This just delays treatment, annoys the patient because they are passed from pillar to post and puts unnecessary pressure on pharmacy. There is always a lot of talk about reducing pressure on GPs but not on us. You might not need an appointment to see a pharmacist but that doesn't mean it doesn't have a knock on effect to our working day by increasing wait times and our workload! By all means signpost but only when it is appropriate!

As for people with healthy anxiety they need better management by.an actual Gp or nurse to signpost them to the correct treatment whether that be medication for a mental health issue and or therapy.

@Influencerofcrap it’s a tricky one. Some things are obviously not an emergency. But in a local population of, say, hundreds of thousands, in a climate where we really can’t easily just run something by a GP, given that most people don’t have extensive medical knowledge, what do you suggest?

I really hate all the go to a pharmacy propaganda. I remember a few months back it was constantly on the news about pharmacies being the first port of call, how they can treat common illnesses like tonsillitis and UTIs etc etc what a load of rubbish.

I took my DS to the pharmacy when his tonsils were so huge he could barely breathe. Obviously couldn’t get a GP appointment tried the Urgent Treatment centre who had run out of appointments by 10 a.m same day. Rang 111 who said expect a call back within 12 hours. In desperation went to pharmacy who reluctantly looked down DS throat (practically had to beg) who immediately said needs GP appointment.

I once ran out of my pill saw pharmacist in Asda who wouldn’t give me an emergency supply due to his religious beliefs.

Once took DD who got bitten in the garden & her entire leg swelled up. Went to a pharmacy again told need GP appointment.

I work with someone whose brother is a pharmacist he told me not to bother with them!

Maybe I have been unlucky - I live in the south east so not even in the middle of nowhere.

I think the go to a pharmacy stuff is really for people who go to their GP with colds and sore throats and just need a lemsip or a cough drop.

But of course, anything you or your precious family have to pop to A&E for will be more legitimate, won't it OP?

And, pray tell, did you learn the term 'walking anxious' from Rupert Murdoch?

How about another term 'Blame those in need, rather than those in the lead'.

Hope to christ you're not in my friendship circle.

joyous yes I think you’re right. When the pharmacist saw DS throat he said all he can offer is over the counter throat spray and lozenges.

Maybe GP's could run a similar service to a minor injuries or A&E? I would wait 8hrs to be seen by my GP these days. I could book the day off work if I knew I could be seen

But I can't even book an appointment at the doctors because the lines open at 8.30 when work starts. And if I could, its only so they can call you back - which again I can't take because I'm at work. They close for lunch until 2pm after which it's emergency appointments.
I'd have loved HRT from the GP to offset my menopause systems but had to wait until I had serious chest pains and get sent to A&E via the minor injuries clinic. No heart attack. Most likely the cause was the same as aches and pains in my joints. My poor GP had to waste time inviting me in ...via the appointment system - which I can't access.

I work for MH trust - it’s clearly a waste of time.

In the past saying you felt suicidal had a massive taboo and stigma. So only those in the worst mental health tended to say that. Now people say they feel suicidal if they feel really bad, but are never going to kill themselves. So staff have to try and assess who is at real risk. But that assessment is never going to be 100% accurate.
And it is a myth that people who are really suicidal do not seek help, most do. But assessments are hard. We know from people who have survived serious suicide attempts that most decide ti actually do it in a very short space of time.

I also notice more parents talking about their children attempting suicide, when their children are actually self harming.

I've been on one for three years and still waiting.

A&E is not for health anxiety.

I agree there's less stigma to it now so people are more likely to be honest.
I can believe there are people who just throw the suggestion out there without really meaning it.

I also agree that it's not true that someone's not really suicidal if they ask for help - but that's why I object to this idea that people are either imminently about to kill themselves or not really suicidal at all.

Surely once at the stage where they are actually going to do it, they won't tell anyone, because people would stop them. It's the bit where someone's thinking about it as an option but still reaching for help/other options that they need to be taken seriously, surely? (I don't mean immediately hospitalised, in most cases, but to be taken seriously and some pathway to recovery available.)

As I said, I lost a friend for precisely this reason. So many times being turned away in crisis, no therapy or anything available for her. Generally treated like a waste of time. So in the end she opted out, and obviously didn't bother telling anyone because she thought (knew?) there wouldn't be any help, based on all the times she'd asked whilst she still felt it possible there might be.

Issue is, a GP will just send you to A&E. I was sent there after seeing a GP, if they GP could send you to a specific wards or department that would be better. But no, you have to go to A&E and join the queue with everyone else

It’s become common to blame individuals and not a system that is no longer fit for purpose.

My best friend said a number of times in the weeks leading up to her death that she was frightened she was going to kill herself. I lived a long way from her but we spoke for weeks on the phone, several times a day and I did my best to listen to her, love her, and encourage her to seek help. I was unable to travel. The help she received was not helpful at all. She told everyone who would listen that she was suicidal, and she was. And she succeeded.

I do not believe the bullshit that the people who mean to commit suicide don’t talk about it and that they just do it. Some don’t talk about it, but some definitely do. Some talk about it and don’t do it. Good luck deciding who is who. That should be the job of the qualified professionals and they should be accessible. Not understaffed snd spread too thin.

It varies - there are levels of suicidality which change rapidly sometimes. So risk is present but not in ‘crisis’.

There is no one set of events/factors that happen across individuals that enable clinicians to predict someone will act and succeed - it varies there is no reliable formula to guide decisions

If some has capacity MHCP cannot force people to engage with services.

The biggest issue for services is waiting lists for therapy, a lack of staff, and a lack of rooms. For some presentations there is not a distinct pathway.

Self harm primarily is about emotional regulation, it is not because of a desire to hurt themselves. But self harm is also a risk factor for suicide, statistically speaking.