Refused access to psychiatric services - catchment issues

[soloula]

A family member has had problems with their mental health (depression and anxiety related) for the last few years. They have been in regular contact with their GP over this time. It has gotten worse over the last few months. It's not crisis point but they are really struggling now. GP referred them to a psychiatrist and in the first consultation the psychiatrist upped their meds and started to look into a care plan that involved more involvement with psychiatric services. This is where our problem is...

Relative has been registered at the same GP for 20 years. They lived and worked by the practice. They moved outwith the catchment area about 15 years ago but because they continued to work locally they remained with the same GP. GP were always ok with this. However, psychiatric services say that their rules don't allow them to treat someone who lives in a different area because if there is a crisis then their teams can't help.

Now, I do understand this but the problem is family member is self employed. Finances are very tight and moving GP to where they stay means closing early for every appointment, psychiatric/GP or otherwise, losing money every time. This isn't an option. This was the reason they remained registered at the original practice. Family member is already feeling very low and is even more so now they are having to chose between treatment and potentially their livelihood. Family member is not at crisis point and never has been in the time they are experiencing these problems. So that's not an immediate concern but the issues that they are experiencing that are having an impact on their day-to-day living are but psychiatric services won't get involved.

Can anyone point me to where I can find out what their patient rights are and if there is anyone that can help resolve this. From what I've read, their needs need to be taken into consideration but this isn't happening. I could understand if this was the first time they'd sought treatment since moving out the catchment area (they moved away in 2007) but they have had all sorts of treatment while not living there (xrays, scans, hernia op, vaccinations...). It's never been an issue before and now when they really need treatment they can't access it because of red tape. We're in Scotland.

Ask the GP to refer them to the team in the area they live. There shouldn’t be any problem them doing that. Or the patient may be able to self refer in some areas.

The psychiatrist has said they'll do this but the problem is because of work and finances they can't attend in the area they live. The business closes at 3.30 but this can be later depending on customers (it's a food business so sit in customers may mean slightly later closing). So there's never been an issue getting appointments for when it's closed in the city they work, as most places they've been referred are 10/15 mins away at most. But they can't physically get to an appointment within working hours in their home area as the distance they have to commute back means closing early and losing custom. Or not closing early and then not having time for any appointments. For regular appointments, like say they have counselling, this has massive financial implications. And massive implications for their mental health and wellbeing if they can't access the support available because of this 😞

They can probably do the appointments virtually on teams?

Mental health services aren't included in the general "choose where you are treated" stuff.

www.nhs.uk/common-health-questions/nhs-services-and-treatments/can-i-choose-where-to-receive-treatment/

But your family member is probably in a difficult position. Many secondary services base their referral criteria on GP (so will only accept patients who have GPs in what used to be their CCG areas). Your family member would be in the area they want to be based on GP but not on postcode.

It sounds like they are almost going to end up being treated as an out of area referral in their home location.

Lots of GPs won't keep people if they move out of catchment and refuse out of area patients because it causes these sorts of situation.

I doubt that services would allow the referral to the mental health team near work on the basis that it would make it less likely to need time off for appointments anyway. Appointments are in pretty short supply and people are expected to work round getting to them for the most part.

Second what a PP said. If your family member isn’t in crisis, the actual F2F input they’d be looking at getting from the Cmht is minimal - an hour long consultant assessment, maybe some follow up phone calls to check on meds, potentially signposting to relevant groups etc. Most if not all of this will/can be done over the phone or video.
It really wouldn’t impact on his business. And if on the unlikely occurrence he was offered a F2F consultant assessment this would at worst entail opening his food business an hour later than usual…hardly an ongoing hardship likely to impact him any worse than his current MH is.
To bring about MH improvement it does require some give & take on the part of patients - treatment is offered Mon-Fri 9-5 just like most other non-urgent services such as physio etc.
If your family member had a slipped disk & needed a course of Physiotherapy at the same hospital then the same flexibility with his work would be needed. You can’t change NHS trusts just to minimise the need to take an hour off work.