To think ds shouldn’t be discharged from the cmht

[Covidisloation]

Ds is 25 has been under cmht five years. He has had admissions and also been on police sections. He’s not had a major incident in about six months. They are now saying they are planning to discharge him next month. I think their support is what keeps him stable and he also goes downhill very fast.

I can see you’re naturally worried. What is the discharge plan? Will he go under GP care for monitoring
Is he subject to s117 aftercare?
You need to know how to initiate referral or see the home treatment team if he deteriorate
What’s your son understanding of the discharge

He will go under gp care but he doesn’t feel able to be open with the doctors at our surgery. I don’t believe he will seek out support from them. He’s never been on a section 3 only section 2 so no aftercare unfortunately. He says they think he’s ready as he’s not as unwell as he once was.

Have they had an MDT that includes yourself and your son?
Cmhts are super pushed at the mo, so alot of them are discharging the stable people on the case load to make space for those who are in crisis. But if you honestly feel he needs the support please speak with his care coordinator - they should remain even if he is discharged.
Would also suggest getting a crisis plan on paper with your son so if he does become unwell again you have a plan and a list of early warning signs.
Also, depending on diagnosis there's groups out there to offer peer support - Andy's man club or hearing voices groups if he experiences psychosis

Is he on CPA? Guidance for considering discharge from CPA does say that they should consider whether it's the CPA support keeping someone stable rather than that they are ready to be discharged.

There needs to be a discharge plan
However realistically with COVID support will be limited and predominantly online or by phone

He’s on a cpa yes. He’s only had phone support throughout Covid. He had a phone appointment with a psychiatrist who stated he thinks he should be discharged.

Have spoken to the manager today. She’s saying due to high number of referrals they are discharging most of the long term patients.

I don't think I can offer much help here but if he is discharged into GP care but doesn't feel he can be open with them is it possible to change surgeries? I have a fair few to chose from in my area but in another area I lived it there were only 2 so realise there might not actually be much choice. I also know change surgeries might not solve this either, he may still find it difficult to be open with them.

Thank you.We live very rurally and unfortunately these only one surgery that takes patients from our address.

I’m a GP and understand your concerns. Volume of traffic is a real issue for CMHTs at the moment and they’re fire fighting with very limited resources. It’s great that your son has been well for a number of months but of course we all know he has a risk of that not lasting. Long-term CMHT patients are much rarer than they were 10-15 years ago - so few people seem to meet whatever threshold is required for long-term support and it’s very frightening for patients and their families.

What I would ask for if they insist on discharging him is a fast-track re-referral or contact number in case you/he are worried he’s becoming unwell again, given that he has history of rapid decline. It essentially means he will skip all the usual waiting/triage and can just contact the team directly. I have seen this done a few times and it at least gives you a safety net although doesn’t remove the problem entirely.

I would also gently suggest to your son that it would be beneficial for him to try and build a relationship with a GP. Are there any that he feels he could approach, even if not for a long heart-to-heart initially? It may feel easier with email or phone appts that so many are offering now. At some stage he may need to see a GP - about anything, not just his mental health - and this would be a valuable exercise for him in that case. Maybe you or he could ask around to see if any of the doctors sound like a safe bet (but try to not pick a trainee, if they have
them, as he will then need to start all over again when they leave).

I hope he stays well

I think it depends on how they are supporting him.

If he is not receiving any active input (eg undergoing med changes, therapies etc) and has been stable for a while and been able to maintain that with very limited input over the last year then its difficult to argue that he needs to continue to be under their care

I agree about asking for a relapse plan, signposting to further support eg local mental health charities, helplines etc

He speaks to a nurse every few weeks which he finds helpful. He won’t get that with our gp.

Actually a GP may be able to provide that for him. I certainly have patients whom I speak to or email every few weeks - some with mental health issues, palliative care patients and so on. Obviously it would need setting up but this is something we do pretty routinely for people with long-term conditions. Generally what happens is that over time the frequency of the contacts becomes less but that’s not always the case. Once you have that relationship though it’s then very easy to step things up if required.

Have they referred him to any local mental health charities? When I was discharged from CMHT, my CPN was pretty much swapped for someone from MIND (the service was called 'Step Down').

I am in exactly the same situation as your son. Now discharged I have had no aftercare whatsoever and could have been dead for a couple of months. I'm sorry to hear of the situation- I hope that your son having your support will help. Perhaps look into private care?

Prestissimo Unfortunately ours won’t they have said they can offer him one meds review a year unfortunately. Thanks will look into mind I know we have branch in our town. PurpleFrames I’m sorry to hear your in the same situation it’s really awful.

It’s a capacity issue, community teams & psychiatrists have huge caseloads and waiting list
Referrals have (understandably) increased. Teams have a finite capacity a manageable ft caseload is @25. In order to safely manage capacity and meet statutory requirements, the team caseload needs to be manageable. A systematic review of cases will triage cases and identify who can be stepped down to primary care.

Do write to your mp and councillor and impress upon them the woeful underfunding of community mental health.