NHS mental health team referral rejected - can anyone shed some light?

[wawawewa]

Back when I still had a job that provided health insurance, I was seeing a private psychiatrist. I have had serious MH problems my entire adult life to the point of needing residential treatment on multiple occasions, and I remain on high doses of three different psychiatric medications.

I can no longer afford to see the private psychiatrist now that I don’t have insurance. He wrote to my NHS GP to ask them to continue prescribing my medications so I wouldn’t have to pay for those privately, and this has worked well.

At my last GP appointment, I asked if I could be referred to a psychiatrist/mental health team/someone or anyone within the NHS system. I’m stable at the moment, but when things get bad, they get really bad, and I want to be under some kind of MH care for when that happens again (sadly it’s probably a “when” not an “if”).

I highlighted to my GP that I felt strongly that I needed specialist help, and that I was really worried about another bad episode coming on - and that I don’t want to be on a waiting list with Samaritans on speed dial when it does. I also highlighted that it was important to me to stay on the medication I’m taking right now - it was a long and difficult road to find the right combination, and I don’t want to change it now that it’s working.

My GP made the referral and got back to me saying the referral was rejected, and that the MH team would only see me if I wanted to “reduce or stop” my medication.

Of course I understand that the NHS is under huge pressure and needs to prioritise urgent referrals, but I’m a bit surprised that mine was totally rejected given my history? Surely I could have at least been put on a waiting list? Who does qualify for the referrals, only people who are in crisis at that very moment?

Can anyone shed some light on this?

Did they literally refuse you a referral for any form of therapy? Like CBT etc? They might not think you need a psychiatrist if your meds are working and you're stable on them. But surely they could offer talking therapy? If not that seems out of order.

In my area they will only see you if you are actively ill and will discharge you as quickly as possible. I’ve been under the mental health on and off for years and they won’t keep you on just in case you need them.

We don’t see people who are not currently ill ‘just in case’ What would the psychiatrist do? Just have a chat to you? We are overwhelmed with all the people who are currently ill. If you become unwell or wish to make changes to your meds thats when they would have a job to do and a referral would be justified

Having said that, they’ve always been quick to see me due to the nature of my diagnosis and I’ve normally had a call the same day as the referrals and been triaged. If I’m bad a key worker will contact me same day and arrange to see me - if I need to have my meds reviewed urgently then they will arrange for a psychiatrist to look asap.

Unfortunately in my experience you have to be in crisis for the nhs to accept you. They dont see that it would be cheaper (and better for patients) to maintain relationships and prevent crisis. It looks better on paper if patients are discharged or not put on long waiting lists.
I have ptsd (ironically caused by the nhs). Took them 10 years to give me emdr then when they deemed me 'stable' they discharged me. I went from weekly intervention to nothing. Two years on I could do with support but I'm not at crisis point so they'll not even put me back on the very long waiting list.
I'm not much help to you I'm afraid. But definitely understand your frustrations.
Have you looked what support nice guidelines say the nhs should provide you with?

@BillieWiper nope, absolutely nothing…
@KurtCobainLover I don’t think “keeping you on just in case you need them” is what I’d call it - surely there also needs to be preventative and continuous healthcare!?

The way the NHS mental health system works is that if you're currently stable then they won't accept a referral for anything other than talking therapy until you actually have a crisis. The NHS a reactive system rather than a preventative one therefore if you don't have a direct 'need' then they won't accept. They apply this to mental health services as well.

Not having all the resources taken up by people having routine check ups ought to allow for faster access for people in crisis.

OP didn’t say that she wanted talking therapy but she can self refer to NHS talking therapies in most areas of the U.K. if she does.

If in crisis call NHS 111 and select the mental health option or go to A&E rather than the GP and those will provide a fast route in to services (if it is justified at that time)

@MumtoGPW yes, I’m really shocked at the complete disregard for preventative or continuous care

It’s been this way for at least 30 years, you must be living under a rock if you don’t realise how bad and underfunded NHS Mental Health services are

I am not saying that there wouldn’t be a role for preventative care but the NHS does not have the luxury of that. You’d also be very lucky to see the same psychiatrist or MH worker twice given our recruitment and retention issues so the long term relationship doesn't apply. You are used to the luxury of private services. That’s where the money you pay in insurance goes to a better service.

There should be, but there isn't. You'll have to wait for a crisis and then you 'might' get lucky.

ok, I guess I have my answer. Thank you to the posters who gave explanations.

I do feel like dismissing preventative care as “just in case” or “having resources taken up” is pretty sad. I understand that it’s a system under huge pressure, and that it’s just not possible right now, but come on.

It's just not the NHS model. As an example, I developed arthritis in my fingers to the point I couldn't work. My referral took 6 months to go through and then the rheumatoid consultant was extremely rude because my GP put in an urgent rather than standard referral, he actually told me I don't walk on my hands so what was the problem. My fingers couldn't be straightened. He advised the GP to use extremely strong steroids and I got the use of my hands back... That's just one example in the millions of people using services everyday. I work with young people and CAMHS are on their knees, there's not the funding or the staff available to be preventative

Surely I could have at least been put on a waiting list?

I guess that is the crux of it for me. A waiting list for what, exactly? It sounds like you are happy with your current treatment and want to be sure that the NHS is there for you if/when you become acutely ill again as a result of your longstanding illness.

Would it be right to say that what you need, essentially, is reassurance that urgent care will be there when you need it? Insofar as adequate urgent care is actually available on the NHS, it should be available to you immediately should you become severely unwell. It isn't a question of getting on to a waiting list first.

Or is the deterioration that you fear more gradual, not quite sudden and catastrophic enough to need an emergency intervention? I can see that you might then want to be already on someone's books, as it were.

I guess a key question would be: how would this have been managed if you had been an NHS patient all along? Depending on your condition, it is entirely possible that you would have been discharged from specialist NHS care once the medication had been sorted out well enough to keep you stable. And instructed to contact your GP if things started to go downhill. So you might not be any worse off as a result of having used private care in the past.

If your condition involves the possibility that you might get significantly worse, but not bad enough for emergency intervention, I'm sure that the GP could make an urgent referral, which might make more sense than the 'preventative' referral that you expected

I have been stable for four years but still see psychiatrist at NHS every six months. I don’t understand why as I have always been fine and taking my medication.

In some areas if you have a s117 entitlement they have to keep you on for a 6 monthly review. It might be that.

There has not been any sections.

That's awful. Could you see a different GP at the practice? I hope you find some help x

Without knowing your history and the meds its difficult to say ( nurse who works in Psychiatry/ spent many years in CMHT and access / triage services) but from what you have said its likely because you are currently stable.

Services now work on an ‘episode of care’ type model, so if you start to relapse or if for some reason you can longer take your current medication regime, then there is a piece of work for services to do there.

They won’t accept or keep people on for monitoring type work, even when there is a significant risk of relapse as they would be literally inundated.

I suggest making a crisis/ contingency type plan and sharing that with your GP and any trusted people in your life. Then alerting your GP at first sign of relapse whereby they can re- refer you.

If you struggle with suicidal ideation then the ‘Stay alive’ app is good and endorsed by the NHS and you can populate it in advance of a crisis.

It might be due to the specific meds you are on as some ‘red drugs’ and some ‘amber drugs’ GP’s cannot prescribe without specialist monitoring.

I wonder (I don’t know) if your diagnosis and meds are relevant here. I appreciate you might not wish to say.

For example, I was discharged from CMHT with a bipolar diagnosis after an episode of hypomania and being sectioned in hospital for a month. However my GP immediately requested that I be permanently under the CMHT because lithium is a specialist drug. I now have an annual review and open door access to CMHT if I feel I’m having an episode.

As your GP is able to continue the drug regime that works for you currently. There isn’t anything for CMHT to currently do. If you need to know where to if you get unwell, I can certainly understand that. I would assume it would be 111 option 2 or via your GP. During my last episode, calling the crisis team wasn’t as successful as calling my GP and asking them to intercede on my behalf. Now my condition is known and I’m not a danger to myself or others, my urgent need for a medication review didn’t feel urgent to them until my GP spoke on my behalf doctor to doctor. I don’t trust the system to work now. I have a good consultant but people can change jobs anytime .

I take lithium among others and I have schitzoaffective

I would expect you to have regular reviews and stay under CMHT care like you have been then, based on my experience. Your and my conditions require drugs that GPs don’t have detailed knowledge of prescribing. GPs I think are more used to dealing with unipolar depression and prescribing drugs for depression, anxiety etc. But I don’t know really - my experience is limited to my condition and my part of the country.

We discharge people who are stable on lithium and antipsychotics to the GP in our area. The only people who stay under 2nd care are on clozapine or have a S117 entitlement. Less routine review slots leads to more available slots to respond to urgent referrals which can be seen in 5 working days. People should also have done work on avoiding triggers, staying well and have an early warning signs/ relapse prevention document. Then when warning signs occur an early re referral can be made.