How poorly do you need to be to get a referal to see a Psychiatrist?

[ElfandSafety]

Just a general question .
I know everyone is different but say you have suffered from chronic depression with suicidal ideation for a long time. Say you are on the top dose of a second line antidepressant after trying many other types of meds. What happens if your depression is caused by something that is completely out of your control and has no prospect of improving.
When exactly do you think that your GP decides you need further intervention?
Any response would be really appreciated.

That's a very good question, ElfandSafety - I think that they're supposed to use the NICE guidelines, quick ref guide here

I feel clueless about why I saw a psych, so I can't really help with that.

I am unsure my GP didnt refer me. I went to GP having experienced mania and pychosis depression self harm and suicide plans (luckily felt normal before I got to the date) for a few months and he told me go straight to crisis as I couldnt wait. Crisis wanted to admit me but I told them I felt fine now (hence being able to ask as I hadnt seen I was ill while I was ill IYSWIM) and after my mum and partner said they would care for me and any further symptoms would call and get me admitted they let me go and I was refered by crisis not GP. Have you tried crisis?

Hi, I work in mental health and have done for a number of year but do not claim to be an expert, I also have personal experience of depression. Usually the GP will take into account a number of factors before taking any further action, mainly taking into account what you have told them and the perceived level of risk.

If you feel in a crisis and are considering acting on your suicidal thoughts there should be a mental health crisis service in your area and your GP should be able to give you the number or refer you. If the GP cant or wont and you are seriously worried about what you might do go to A&E. They will have a psychiatric liaison.

If you feel able to keep yourself safe but are losing hope because of your symptoms the following might be helpful. You may feel that your depression is caused by something out of your control and has no prospect of improving and this may be the case, however the way you view that cause can change and that can have an incredible effect on your depression. Unfortunately changing this view can take a long time and can feel like way to much effort for someone who is chronically depressed. However if you find medication is not achieving the improvements you hoped for it may be worth thinking about psychological therapy. There are a lot of different things out there so please don't write them all off if you don't like one. Those with the best evidence base for depression include CBT (Cognitive behavioural therapy) and mindfulness. Unfortunately waiting list for these on the NHS can be long but its always worth asking your GP. You can get a number of self help books but again speak to a professional before purchasing one as some a full of rubbish. Overcoming depression By Paul Gilbert is a good place to start (about £8.50 on amazon) however it will take some perseverance. The worst thing about any mental health condition is there is no quick fix.

There might be a charity in your area that either offers low cost/free psychological therapies or that can help you find one. Try MIND or RETHINK. A charity near me offered massively reduced psychotherapy which I attended for 18 months and I have noticed a massive difference my whole life has turned around, but like I keep saying it can take a while.

All the best, and take care.

Really your GP should refer you whenever the treatment they are trained and qualified to administer is insufficient to help you. You don't have to be suicidal for it. I know that if I ever need ADs in the future my GP will ask a psychiatrist to prescribe as we have found to my cost that I react badly to mainstream modern ADs. Nothing to do with being mentally ill but everything with the psych's greater knowledge of medication.

If you feel that you would like to see a psych to explore a greater range of treatment options you can ask your GP to refer you, you don't have to wait.

I thought that referral to a conslt psych was on the basis of clinical need determined by the GP. I think statistically 1 in 10 people who visit their gP get referrred. When I wanted a referral for a physical illness the GP said it wasn't necessary, so I paid to get the referral and the GP was right, there was no need for seeing a specialist - it was actually health anxiety. Madmouse may be right and you can ask your GP for a referral - that should be how it works, but on the other hand the GP does have to make sensible decisions about referrals. My practice is very quick to refer for physical illness and the GP who came out to see me when I was severely depressed last year, immediately referred me.

I think having suzic84 has some good advice, and upwardandonwards link too will be helpful to you. I haven't read it yet, but will do later, just out of interest. There is also a CPN on this thread but I can't remember her nickname. She gave really good, helpful advice on a thread just a few days ago.

Thank you for all your replies, really helpful.
I think it is a case of when the depression has been so prolonged and serious is it unreasonable to think that perhaps seeking specialist advice may be benificial?
When does the GP reach that point?

Have you discussed it with your GP, they will be able to tell you the criteria for your local CMHT?? As much respect as I have for Psychiatrists they are not the only specialists out there and have very little to do with most mental health suffers other than diagnosis and medication management even then they can get it wrong and it can take ages to get right.
I know it is reassuring to have seen a specialist but they don't always have all the answers. It is really worth exploring what support is available in the community as that is where you are likely to find most support.

ElfandSafety - I am wondering could it be possible that you have drug resistent depression, as I know that this can happen. I think firsttimemumtobe has a good point, have you ever discussed this with your GP or are you just hoping that this will happen, given that your depression has been so prolonged and serious. I agree to with what FTM2B says about psychiatrists, their main task is diagnosis and treatment and they don't always get it right, and yes if one AD doesn't suit or provide any relief, there are others that can be tried, but of course the trouble with that is you have to wait a month to see if they "kick in" or not.

If you haven't already I think you must request that your GP refers you to a conslt psych. Is your GP aware of how prolonged and serious your depression is and the way it is affecting you life, or are you someone who doesn't really tell it how it is. If not, you must do so!

I agree also that there is help within the community but I think this has to come after the diagnosis by conslt psych because CMHT people can't prescribe. Maybe you could ask your GP about referral to the CMHT and sometimes this is a CPN and sometimes a social worker with expertise in mental health. I had a CPN who was really helpful but I had been diagnosed and treated by a Conslt Psych at the time i was admitted to a psych ward. The CPN was part of my post discharge package.

I don't want to alarm you, but when I was in hospital last year, I was amazed to find that ECT is still used. I asked a DR onthe ward andhe said it was nothing like the old fashioned methods, where people shook and it all looked horrific. People now receive muscle relaxants and sedatives and can't remember the actual treatment. Their memory can be affected for a day or two. I saw many patients having ECT who seemed to be perfectly ok when they came back. In fact the ward manager told me that if she had drug resistant depression, she wouldn't hesitate to have ECT as it was the best method for these cases, though it is always used as a last resort.

I think you should talk to your GP about how bad things are for you and request that referral, which seems to be overdue.

Firsttime no in fairness to the GP, I have'nt requested this but as the months go on and on it's kind of depressing to wonder if this is all the future holds plus she is the doc and I do trust her judgement.
Nana thank you that was really useful, yes I have been completely honest with the GP, this GP has been treating me for the last few years.
Scary stuff about the ECT, in a previous life I used to work in Forensic Psychiatry and saw just how gruesome the treatment is - still works for some people though or did then anyway!
I hope you are doing ok atm Nana and everyone else.
Really do appreciate you all taking the time to post.

Elf
Hope this is of some help. The BMA publish various books which are readily avaiable at local pharmacies. The one on Depression costs c.£6 and gives some good basic understanding of how your GP assesses things and further options (you can also buy on-line). Guess in a world of blogs it us concise and factual. X

Elf - my FIL has explained this to me. He says that there are so many unnecessary referrals to CMHTs that some GPs are wary of sending anyone who they can get to a state of coping without having to refer them. Having said that, if you're feeling desperate, it's important to say so, and ask for a referral. Maybe your GP isn't aware how awful you're feeling?

Hi Elf - as you were working as a forensic psychiatry, you are probably very knowledgeable about various treatments. I'm wondering if this is a low lying chronic depression that you have, where you almost just accept that you are depressed, as opposed to an acute episode, when the medics refer to psychiatrist or CMHT. Can you say a bit more about how you do feel and whether there are periods when you feel ok and not at other times. Am assuming you have children, do you have an H or P - and if so is he supportive of you, as that can make a big difference.

Yes I know ECT sounds scarey but it apparently isn't gruesome any more. I used to see patients going to the main hospital for ECT and they were fine when they came back, maybe a little tired, but that's all. There was one woman on the ward who was out of touch with reality, she was trying to take off her clothes, asking everyone if they had sold her bungalow, agitating because she couldn't pay for her bed etc. I was just admitted and assumed she had alzheimers (as I was in the older people's ward cus I was 66) and most patients were in their 80s. After a few days, she was perfectly normal and had no knowledge of how psychotic she had been. Her daughter told me that she had had severe depression with a psychotic episode (about 3rd episode over the years) and that ECT was the only thing that worked. She said "thank god there is something to help mom" and it turned out she had had 6 ECT treatments and after the 6th treatment she returned to her normal self and we became quite friendly. She was no longer depressed and actually went on holiday to Austria before I was discharged. So for me the facts spoke for themselves.

I am a bit up and down at the moment, woke feeling crap today and had good cry and feel slightly better - I do improve through the day, but I still hate this bloody depression.