To please ask any GPs?

[LemonSwan]

Hello,

I anyone can advise it would be greatly appreciated.

I was called today by a team who are doing Annual Health Checks as part of some kind of continuing mental health care.

I had an acute psychotic episode requiring inpatient treatment (30 day section 2) around 3 years ago and finished treatment/medication shortly after (less than 3 months) and haven't received medication or any continuing care since.

I asked the woman on the phone why I was being invited now?

• 3 years after the fact. And she said she wanted to check how I was doing with my current MH medication which was on my record as being ongoing. I explained I haven't taken or been prescribed any medication for 3 years - which she seemed perplexed by.

Since getting home I have googled and apparently this is only offered to people on the Severe Mental Illness register.

I was unaware I was on such a register; but it may explain why my life insurance was declined out of the blue a few months back after I had been assured by the assessing underwriter at interview that it would be expensive but certainly not declined as a one time acute episode, no longer on medication, and no longer being treated.

Can anyone shed some light on any of this?
Ie.

• are these checks only offered to people on this register
• requirements to be on the register
• why I may being only contacted after 3 years
• can I ask to be removed from the register or my records updated to show I am not receiving treatment etc?

Thanks in advance,

Unfortunately AFAIK it’s actually very difficult to be removed from a Severe mental illness register in GP (the rationale presumably being that you may be at higher risk long term of adverse health outcomes than someone who has never had such an episode- the point of the SMI register is to try and reduce the health inequalities than significant mental illness sadly often brings.)
Your GP can’t just delete the diagnosis from your notes and once it’s there it is automatically captured for the register (I work in Scotland where these registers/targets are no longer part of our contract so I’m going by memory a bit)
It might be possible for your GP to change the code to something like ‘history of psychotic episode’ which I think might not be captured by the SMI register codes. Or you can just ignore invites for review and you will just be coded as declined review. I don’t think bring on the SMI register alone will have an impact on life insurance, it will likely just be that it is still too recent in underwriting terms for the insurer. Mental heath charities might be able to point you in direction of specialist insurers or the longer you stay well the more likely insurers will be to cover you.
Covid is probably the reason you haven’t had a review before depending on dates. These targets were all
suspended in 2020 due to covid and practices will be playing catch up now.
I hope that helps - happy to be corrected by anyone currently working with these registers as it’s a few years since I have!

Thank you checked for your insight

COVID makes a lot of sense as to why I wasn't called previously.

I am unsure whether to go to the Annual Check or not.

I dont want this to count as continuing care and prolong the time-lapsed for the episode to be deleted from my records (which I think is 20 years)

The insurance company won’t have access to the register it will be because of the information you have told the broker. I’ve been turned down for critical illness a few times and each time the broker has been confident “it will be expensive but you will get it” I have a set of circumstances that because of the previous history, my job and salary make me uninsurable 😂 none of which are remarkable at all it’s just the combination.

It’s not being on the register that is the issue it’s the fact you’ve had an issue that’s the problem.

It’s good you’ve recovered so well and maybe try again in a couple of years as time does make a difference for this type of thing.

Thanks Oinky, I am sorry you have had similar issues.

Oh yes brokers are useless - but this was the assessing underwriter ie. the actual decision maker.

He said as long as my records matched what I had said then it would be no problem.

Its only after my records returned that there was a problem, which they wouldnt specifically disclose.

I am worrying now that it is because my GP thinks I am still on medication and still having ongoing long term treatment.

Declined review will just keep you on the Register at increased risk as they haven’t seen u so have no idea if your ok. If you go to the review demonstrate all you’ve said then they’re likely to step you down from the monitoring?

I would double check the medication dates/information as that could impact but even the underwriters won’t have very many instances where people are totally turned down.

I’m a dentist and have had anxiety and a neck issue so apparently it’s game over for me, the combination of the three is bad. I’ve ongoing neck/back/shoulder issues I’ve managed with physio and never troubled my GP with for 20 years, I then had one episode of random nerve trapping I had to go to my go for help with that resolved in a week with no trigger related to work or recurrence and that means no insurance for me 🤷‍♀️ I could probably need to try some specialist companies but haven’t got round to it. The last broker was in total disbelief but I did get the small satisfaction of saying I told you so!

Thanks ANP2020,

I would hope that is the case. Are you a GP and know this is actually how it works?

I should probably or I do need to try some specialist companies! I wish there was an edit function on Mumsnet

Oinkypig

Oh gosh that is awful! I understand the risk needs to be accounted for when you get covered, but it seems that getting quickly treated and recovering puts you at more of a disadvantage than allowing the problem to develop into something chronic and untreatable. It seems quite unfair.

I have checked on NHS App, and noticed my medication from 3 years ago says 'Unknown Date' and is being stored at the top of a chronological list (above a prescription from last month); and has a note saying 'Under local MH team Currently'.

And the lady on the phone for Annual Check seemed to think I was still on medication and still being treated.

I'm not a GP but as far as I'm aware you're on the SMI register for life, though after five years without needing treatment you're considered in remission and they don't need to include you in the stats…?

Thanks ClumpingBambooIsALie

I am on the register FOR LIFE!

Jees, Well thats depressing

I'm not a GP and only going by what I was told, so it's entirely possible I'm talking bollocks. I tried to read up on it a while back but the info online is kind of… vague when it comes to whether or not you ever stop being on the SMI register.

I hope someone can reliably tell me that what I was told is indeed bollocks cause I'm not keen on the idea either

Hi I'm not a GP but I do the admin for the SMI reviews. You most certainly do not need to be on the SMI register for life. You need to ask for a remission code to be entered onto your records. So if for example you had a psychotic episode you need a code that says psychosis in remission. I think the previous posters are thinking of the mental health register which you will always be on. However once the remission code is added it removes you from being active on the MH register.
That still bothers some patients but as it forms part of their medical history it can't be removed.
Your best bet is to put something in writing for the attention of the data team or readcoder/summariser or the practice manager.
Include how long ago your episode was and that you haven't had any problems since and you would like a remission code added to your records.
Sometimes coders don't always know what to do as it may not be an area they are involved in but they should have someone in secondary mental health care linked to the surgery who can help. That's how I learnt.
Just to add, it's your diagnosis that puts you on the SMI register, not medication, but I would want to get that sorted so maybe add that in your letter too.

Thank you Blossom!

@Blossomsbloom

Thanks for your insight, thats super helpful! I really appreciate you taking the time. I will contact the GP surgery and see if theres anything they can do.

And may I ask one other question please;
Do you think I should go to the Annual Health Check or not?

The lady on the phone said it was only physical health review and as I am currently pregnant I have never had so much health monitoring in my life! Seems a waste of time for a height measurement and blood pressure - which are probably on file from a week before hand.

Or will declining the review mark me as 'increased risk' as a pp said?

@LemonSwan it's probably worth either going to the review or arranging a GP appointment so that your details can be updated properly. It sounds like (probably due to the pandemic chaos) the records are a bit out of date if you're saying that you're not on medication and not involved with any specialist follow-up for your mental health.

The codings and various health registers aren't punitive - they exist to make sure people are offered appropriate healthcare. There are registers for all kinds of health issues, physical and mental. They're absolutely not like the criminal justice system's registers! These ones are just used for organising patient care more efficiently so that people don't miss out on important health needs being met.

No problem at all. Please please don't go by what I'm saying if there is even the slightest concern as I'm not a clinician and don't know your history but when a patient declines a SMI review I message a GP and they check the records to see if it is ok to
accept the decline or whether to pursue it. We don't class a patient that declines as an increased risk just because they declined. There would need to be a reason.
Also, before I can add a remission code I ask a GP to review the records and if they aren't confident the patient is in remission they won't give me the go ahead.
Sometimes it's a real pain getting things like this sorted out but hopefully you'll get there.
All the best with your pregnancy.

@ClumpingBambooIsALie

Thank you Blossom!

No problem, when I re-read my comment I thought I sounded a bit rude saying 'you most certainly do not'! 😂 I didn't mean to!

Thanks again Blossom!

And thank you for the congratulations

I have a midwife appointment next week at the GP so might try to speak to the receptionist then and see what they think.

I am becoming acutely aware of how much exposure I am getting to health care settings - 3 maternity appointments just next week! And I am sure they will agree its both a waste of time and an extra unnecessary COVID risk.

Fingers crossed they are as fabulously helpful as you!

Not rude at all Blossom! Very glad to get your input — as I said I was very aware I might be talking bollocks as I was just repeating what I was told by a health worker, and we all know how stuff can get… miscommunicated.

I get a yearly invite for a mental health review, sometimes I go sometimes I don’t. Haven’t had psychiatric intervention for 7 years.
Does that mean I am one the severe mental health list? I didn’t even know one existed