Community Mental Health Team

[Eightiesgirl]

My dh has recently been taken on by the local Community mental health team after previously being with the psychosis team. What do they actually do? We were told that it's quite difficult to get accepted onto their "books" but we wondered why and what we should be expecting them to do for him? He has been assigned a caseworker but he hasn't actually done anything for him yet. We've been told a care plan will be provided and I filled in forms relating to this but we've now been told that the way care plans are written had changed recently and he was asked various questions and told to rate answers between 0 to 7, which completely confused him. I'd be grateful to hear of anyone else's experience of being with the CMHT.

I’m a MH nurse who works for a CMHT. In general, we do a mixture of social support, ongoing therapeutic intervention and medication management. What that means in practice is that your husband’s caseworker (usually a CPN) will see him regularly-at this point this would normally be about once a week. During those sessions they will talk to him about his daily life experiences and support him with those, help him to engage in structured therapeutic work and support him with his medication. With psychosis he is likely on an antipsychotic so the nurse will check he’s complying with those and talk to the psychiatrist as necessary. If he needs more specialised therapy than his caseworker can provide he can be referred to a psychologist in the same team.
The positives of being under a CMHT is that any deterioration is spotted very quickly and support can be stepped up as needed, including escalating to admission as required-there’s no sitting in A&E/a police cell waiting for a bed. There’s also a lot of intensive therapeutic work that can be done plus support with benefits/housing/employment as required. People are under the CMHT for as long as they need to be with no time limit-some service users have been with us for decades.
The first bit after being accepted is always the tricky bit as there’s a lot of statutory paperwork that’s required (our systems really nag if it isn’t done…) but once he’s met his caseworker there’s a lot of valuable work that can be done. It might be worth thinking about what kind of support he/you need and what you both want to achieve in terms of recovery. Most CMHTs have a dedicated carer worker too, so it should be possible for you to see them independently as well.
I really hope this helps 😊

@Eightiesgirl
I’ve witnessed two different experiences with the Cmht. One mine, one a close friend. We both (unknowingly to begin) went for an assessment for adhd at the same time, a matter of weeks apart. We both saw the same person, who said our cases were complex and needed a consultant.
this is where it differs:
my friend…. The case worker spoke to a consultant on her behalf, confirmed it was adhd, discussed meds and prescribed, supported her with regular appointments and phonecalls, weekly/twice weekly.
mine….. I was referred to the consultant whom I saw in person, after a very lengthy appointment said it was very complex and had come to the conclusion that I might have bipolar instead/aswell….plus might be menopausal at 38…..but would need to treat the bipolar first. I was put on an antipsychotic and left to it, I have had to chase up both doctor and psychiatrist as there is no regular contact.

i think it’s different for everyone, depending on their needs, i should think they tailor it to suit.

@JennieTheZebra
is this normal? My friend has had lots of support, I’ve just been left to it? Same cmht.

@Pibolar
Well, in most areas adhd isn't managed by CMHTs as it's neurological/not a MH condition. Adhd is usually addressed by specialist adhd clinics that then also help prescribe ongoing stimulant medication. I hate to ask, but are you sure your assessment was through the CMHT? All these different nhs clinics can be very confusing. If an adhd clinic suspected bipolar they would usually refer to CMHT for an assessment and vice versa iyswim.
In terms of the bipolar, one off appointments with a psychiatrist are not that uncommon, especially if you're doing ok day to day. Again, it would be very unusual indeed in adult services for the same doctor to do an assessment for both adhd and bipolar as they're very different things. In general, being under the CMHT can mean different things for different people. It does depend on how much help you're assessed as needing and it can be hard to compare different cases.
I really hope this helps and I'm sorry if it's a bit vague

Thanks to both of you for the replies. My dh was taken on by the CMHT last August. He, initially, received fortnightly phone calls then he was allocated a Mental health nurse. This was last November and we have seen her about 6 times at the most. She constantly cancels appointments and every time we see her she goes over the same thing again and again e.g. She will say they are having a meeting about him to discuss future therapy, meds etc then the next time we see her, sometimes week later, she says exactly the same thing but nothing actually seems to get done. In November she had me fill in a very detailed care plan and safety plan that she could refer to whilst creating her own care plan for him. I rushed to complete this, returning it a few days later, but she still hasn't produced a care plan months later. She has even referred to him by the wrong name at one of our meetings. We were treated very well by the psychosis team, he was with them for 3 years and I'm really concerned that the CMHT could just discharge him without every actually doing anything for him. His anti psychotic medication is now dealt with by the GP (who just prescribed what the psychosis team told them to) but we no longer see the psychiatrist from the psychosis team and no psychiatrist has ever been mentioned by the CMHT. I realise they are under a lot of pressure but I wondered if this is normal?

I'm really sorry you've had that experience, it's really unacceptable 😞 you're right that we're under a lot of pressure but that doesn't mean you shouldn't get could care-everyone deserves to be treated as an individual. I would imagine that they see you as "coping". People who are currently stable can fall down the priority list but it's still not fair.
There's a couple of things I would do. Firstly, if he has a CPN he'll have a psychiatrist. I would push for a meds review by that psychiatrist, just so that he's actually been seen by the doctor ultimately responsible for medication. Suggest the CPN comes too, that way everyone is on the same page. Secondly, I would ask for copies of all his letters/care plans. Try and find out what the current plan for him is. That'll give you a better idea of what to argue for.
Honestly, more than anything else you have to make some noise. In MH its currently firefighting so only tricky people get much attention.

@JennieTheZebra thanks so much for the detailed reply. I think asking for a meds review is the way to go to get a new psychiatrist, although his meds seem to be working OK at the moment and he is nervous about changing them. He is due for an ESA review soon so I will have to ask for a copy of his care plan but I have a feeling its not been written yet. Can you please tell me if the way care plans are written had changed recently? The nurse gave me paper forms to fill in all about my dh, his history, triggers etc then when we last saw her she said they no longer do care plans the same way, they now ask a list of questions and he had to choose numbers between 0 to 7 about how he rated his mental health, physical health, thoughts on socialising, his home environment, employment etc This really stressed him out as it was sprung on him at the last appointment and he's been worrying about the answers he gave ever since.

All CMHTs do care plans slightly differently, there's no standardised way. A "care plan" is a structured document explaining
a) who has responsibility for someone's care
b) how often they are seen
c) what the treatment is
d) how deterioration is managed ("crisis and safety").

The first step for putting such a plan in place is to judge how well a service user currently is and so what support they need. Doing this in a numerical way can be useful for staff as it generates a score which can be helpful to gauge improvement, but service users can find having to judge things in this way difficult/distressing. I prefer to have a more general conversation and then write things up longhand as then no one feels they've got anything "wrong".

I do hope she's written something up (in my team we get 2 weeks for formal plans) but, regardless, he has the right to see anything that's been written about him, including general appointment notes. I would ask for copies and then see where you go from there.

@JennieTheZebra thank you so much for that information.

@JennieTheZebra I'm under the local cmht and have a psychiatrist every 3-4 months but just get the duty worker if I phone the cmht.
Sometimes I feel bad phoning them. To be honest I don't phone them often & they don't check up on me.
I have Schizoaffective disorder bipolar type and am quite paranoid at present, keep feeling suicidal at times, they know my mum is extremely unwell with cancer which has exacerbated my mental health problems & I live alone.

@Eightiesgirl it sounds as if your husband has lots of support. The main thing is that he takes his meds as prescribed.
It's easy and very common to start feeling well then think you don't need them anymore!

@ArianahX
When did you last see your psychiatrist? If it’s been a while then I would phone up and ask for an earlier appointment considering how unwell you feel. In terms of not having an allocated care coordinator, this is a little tricky. In some trusts, people can be under a consultant without having an allocated care-co/CPN if they’re largely stable, especially if they have one of the more “organic” mental illnesses like schizoaffective disorder. If you think you would benefit from having an allocated worker right now then you should discuss this with your psychiatrist-there might even be someone on the system already (my trust allocates a CPN to everyone regardless of whether or not they have regular appointments). As far as feeling guilty goes, please please don’t. We want to help people. Talking to people who are unwell is our job and it’s a great privilege that people trust us when they’re struggling. Being able to talk to people is the most important part of my job and the reason I trained as a MH nurse in the first place.

@ArianahX I am very sorry to hear about your mum, it must be so difficult to cope with this and your mental health issues, whilst living alone. I hope you get the support you need from the CMHT, they should be helping you through this difficult time, especially if they are aware of what your situation is with your mum. This is when you really need them. As a previous poster said, they seem to respond to those who shout loudest, so make sure you keep contacting them. My dh has felt suicidal at times and we find contacting the Crisis team helps if no one else is available. I hope your situation improves. There are always people on here happy to talk and offer support, myself included

Thanks @Eightiesgirl & @JennieTheZebra

My psychiatrist is fully booked until my appointment in May but he is aware of how I am at present as one of the duty workers emailed him. He prescribed me some Lorezepam as I went a bit hyper but that's finished now. I'm hoping to return to my part time job on a phased return next week then just take annual leave or maybe carers leave if my mums situation requires it. I just need to stop feeling so paranoid when I go out.

I have been under cmht years. I never saw any care plan. First three years I had cpn but after that I have psychiatrist appointment every six months. I can call duty officer any time and they will liaise with psychiatrist if needed. Last couple of years I have been very stable so no contact apart from six monthly psychiatrist appointments.

@wurtle thanks for sharing that information. Hopefully my dh will get to see a psychiatrist soon.