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?

GP can also ask the consultant for advice & guidance on meds changes without them having to make a referral.

This fits with what happened initially for me but my consultant made it sound like everyone on lithium was back having annual reviews with consultant. Maybe it is just me or individual areas make different decisions. Resources are finite for sure. I wouldn’t know I guess. My GP also messed up completing my DVLA form and my license got revoked until my consultant completed a second form so I think that got into the mix. I am lucky I have a lovely GP surgery and a lovely CMHT too. It’s still a scary situation to be in though at times and the system doesn’t always respect that.

My mother is on clozapine - which has been a wonder drug for her and she’s been on it since it was first licensed in the UK because I remember her having to wait do the licensing process to complete to start it. Her mental health went in the 1980s and that was not a great time to be mentally unwell. I have a lot of memories of medical people screaming at her.

It is a dire situation OP. I lost my private medical insurance recently but I pay myself to carry on seeing my private psychiatrist every two or three weeks. It is really reassuring to know that he is keeping an eye on me and he can let me know when I am losing insight into my condition. In an ideal world that level of support should be provided by the NHS too. I hope you can get a referral arranged.

It will never in a blue moon be possible to see a psychiatrist every 2-3 weeks on the NHS for an unlimited time period.

I struggle to see that this level of highly skilled input is actually required by anyone. Could your friends and family not tell you if you had lost insight and were relapsing given appropriate psycho education and would that not be more adaptive than being dependent on one professional who could retire or move on?

(Of course you are at liberty to do as you please with your own money)

I have to agree with this.

No need to be quite so unpleasant. I don’t have any friends or family

I think that poster meant psych and got an autocorrect

Well I'm.hoping anyway.

Sorry. It was less a typo (although I don’t think I added a space) and more using a technical term
Psychoeducation refers to ‘providing clear information to patients and families about mental health conditions in order to improve understanding, support, and treatment outcomes.’

I honestly had no intention to upset anyone and I am sorry that I did. I just wanted to be realistic about expectations of the NHS

I usually hide the mental heath topic to stop myself being tempted to post but somehow it’s unhidden itself in an update or something.

Have you seen if you’re eligible for an S117 entitlement? I don’t know how strict the criteria is but I thought this was for people who need the type of support provided that you’re indicating you don’t currently have.

My Mum also has monthly catch ups with her nominated mental health nurse.

My area is in the process of bringing all patients taking lithium or valproate back into secondary care with a prescribing nurse.

Cmhts are quite patchy

I was once referred to cmht whilst in a hypomanic episode. The psychiatrist adjusted my meds saying "you work full time you don't meet our criteria" and discharged me without waiting to see if the dose change was going to help.

A few years later under the same cmht I couldn't be discharged from hospital until I had a cpn. They assigned me on but he saw me once whilst I was on leave and then never came back. A few months later a second cpn came twice. The first time she said she wasn't going to leave, 2 weeks later she announced that she was leaving and someone else would be in touch.... They didn't. I went from the perinatal team with weekly cc support to hospital for 10 weeks to absolutely no support and didn't get a psychiatrist review for 6 months.

I've since moved, next cmht accepted referral. Another cpn came once, promised to not disappear like previous cpn. This was September 2022 and I've not seen him since! Although I was technically under the cmht I didn't have any appointments with them for nearly year until I approached my GP and TTC and they requested a medication review.

This reflects my experience - although mine are not as extreme as yours. It feels especially cruel given the nature of illness periods like hypomania - when an external steady scaffold is just what is needed.

Im sure it varies by NHS trust a bit but my experience of the mental health services was strange in parts. Reading this thread it’s answered a big why - I’ve got a serious condition with medication GP can’t prescribe without secondary care input and yet I’ve seen no one (not GP, not CMHT) for years now.

I did find them pretty awful tbh when I was in acute care (not inpatient). They did things like threaten to come and get me when I “missed” an appointment (which they cancelled at my previous appt!!), I wasn’t a danger to others or to myself. Work wasn’t part of the problem but i was told by more than one medical person it would be a good idea to quit my job and go on benefits - I had a very secure, well paid job and was being paid in full while I was unwell. My condition is cyclical and before meds I was triaged for talking therapy during a “well” couple of weeks and told I wasn’t ill enough and didn’t I know there were people who actually need help.

I didn’t get myself sorted until I scraped the money together to see someone privately, and my (very good) GP then prescribed on their instruction. The psychiatrist also worked for NHS in that trust and wasn’t surprised by my experience (although found it appalling).

I look after myself rigorously now to avoid having to go through the NHS experience again - their advice re my job would have been so, so destructive if I’d followed it.

This is not the role of the NHS ,certainly not as things are at the moment

There simply is no funding to see people are currently stable. Funding must go to those in crisis.

I think the treatment pathway is that preventative and continuous care will be provided by the GP

CMHTs are intervention focussed, so won’t offer ‘just incase’ monitoring. There just isn’t the resource.

If there is an intervention which needs to be completed by secondary care then maybe but other wise unless you’re under S117 or on clozapine it’ll pretty much be a no

OP, if you could design your secondary care preventative support, what would it look like?

Even in a crisis you'll be lucky to get a referral accepted.
Passed from team to team for over 18 months with zero actual help.
Pp may say thats not a crisis and its not anymore but months of talking about how id end my life and at times doing things which were close plus very significant self harm which primary care saw and treated for months.
I am not at all surprised people complete suicide.

I will say I was lucky to have great cpn support and see a psychiatrist plus great consistent gp support about 18 yrs ago.
But no chance no sadly.

I think it’s a bit outrageous that preventative psychiatric care doesn’t exist in this country. Other countries manage to provide it, so I don’t buy that it’s a luxury that a country can’t afford. It’s little wonder that we end up with mentally very ill people attacking others with knives if we wait until they are in crisis to then give them the very minimum we can get away with. Apparently there is to be a renewed focus on prevention in the NHS, I hope it encompasses mental health… We as a society pay for it in other ways if we are not going to provide psychiatric evaluations to people who need it. It’s not actually a big ask.
When my DC was acutely ill with OCD, I was told “this does qualify as an emergency, so we’ll put you on a waiting list for urgent care, and in the meantime, hide your knives.” Not only was it stupid advice regarding someone with OCD but it shows that emergencies are not even taken seriously - we waited for six months for a referral… It could have ruined his life, if we’d not had enough money to go private. Compared to my home country where you can see a psychiatrist whenever you want, I don’t get it, what is wrong with this country?
My other DC would benefit from preventative care too but again we’ll go private, even though we can’t really afford it.
Sorry OP, I think you deserve this care and am outraged for you too.

What is your home country and does it have a NHS or is medical care insurance-based?

France. It has an NHS (and a minimal private “top up” insurance system).