To get a psychiatric assessment

[Sunflower49]

I have a good friend I'm currently helping, who has mental health issues.

His GP have been particularly non supportive in the past.

Right now his (private)counselor plus a support group he goes to have both said he needs a psychiatric assessment and some medication.He'd need a referral from his GP for this obviously.

His GP have in the past refused medication and been particularly unhelpful.I have been to appointments with him before and they interrupt him, do not seem to listen to him, have lost information (for example he went for a blood test once and they accused him of not and said they didn't have his results 'cause it had never happened)!

He hasn't ever asked to be sent for psychiatric assessment before though.

Anyway I have a few questions for anybody more experienced with such issues than I am.

1)His boss has told me It's important for his work to be 'allowed' to give him support, for his mental illness to be diagnosed. Is it helpful or unhelpful to mention this in the GP appointment?

2)Would it 'look better' or 'look worse' if I go along to the appointment with him, note I have also expressed my dissatisfaction at their service before so they may be none too fond of me. Will it perhaps look as if the requests are not his choice if I go with him?If I don't, though I'm scared he'll clam up,not tell them the truth, accept things they say and not emphasize the importance of them listening to him.He's very passive with everyone and a definite pushover.

3)What sort of things are best for him to say to up the chances of them actually being helpful and listening to him?
Sorry for how long this is, and thank you.I'm quite frusrtated with this issue,and it is probably coming across in my post. :)

[SilverStars]

If it was me I would go with him. He has the right to ask for a referral and it is up to the psychiatrist and mental health services to decide what to do with him at that level.

An alternative is for him to see a psychiatrist privately. A one off fee can be 150-200 pounds which may be worthwhile?

An official diagnosis means his work then has to make reasonable adaptations to support him etc, which without a diagnosis they do not have to do.

[Sunflower49]

Thank you Silver that's very useful info :)
If they don't support and I do recommend private, this is probably a silly question but is the outcome the same, as in their diagnosis means he will get the medication he needs and his work will have to make the adaptations?His boss is very supportive and wants to help, but as you say she has said for her to be allowed to give full support she needs a diagnosis.

[NanaNina]

I really cannot understand why the GP is refusing medication, as almost always they are only too willing to prescribe, and ADs are very effective these days. I suggest he makes a double appointment with a different GP. and yes I think you should go along with him for moral support.

It is helpful if before the apt he makes a list (bullet points) of his symptoms and then it can either be handed to the GP or used as an aide memoir during the appointment. I don't see any reason why you should be overly concerned about the "best things to say" - the GP needs to know the symptoms so he/she can make a diagnosis. GPs are very well paid out of our taxes and we are the service users, so you have every right to expect a good service, and should not feel cowed by the medics.

As far as a psychiatric assessment is concerned, this is a matter for the GP and statistically 1 in 10 people consulting their GP on a mental health issue (one third of all appts are mental health related) will be referred to a psychiatrist. This is done on the basis of clinical need as it would be with a physical illness. GP is as I'm sure you know, primary care and usually patients are treated initially by their GP and referred on to the relevant consultant if the GP thinks it is necessary, and then you move to secondary care.

I think you need to start with the GP - a different one and take the list with you. I am assuming your friend has depression but you don't mention his symptoms but whatever it is he has the right to be treated properly both clinically and courteously as a patient.

[Sunflower49]

Thank you NanaNina. :)

I will go with him..I do want to was just scared in case I made the situation worse. I'm very forthright and won't accept rudeness and I know this can stress him out (for example last time they began talking over me and I said ' Please, you asked me a question, let me anwer it').

I'm not nasty, just he is so passive and sees me not letting them fob us off, as too much-also because of my complaining I figured they may think I'm bullying him into asking for things-the truth is he's so down he finds it difficult to accept he needs help , and they've made him feel further down for refusing it-he sees it as he's set up to fail so why bother.

They've been very difficult.One reason for the refusal of medication was that he mentioned a few meds that in the past have worked for him, and they told him that they are no longer allowed to prescribe these (this is true I looked it up,they're down as 'controlled drugs').They offered no alternative and suggested he joined a support group (which he has).

However he has asked them since and they instead suggested he makes another appointment to talk to them about stress.

They suggested this to me when I went to collect his sicknote, and I had a bit of a go at them as at the time he was feeling totally failed by them as they'd been so little help,he was too stressed to go into the place!

I told them that they were currently a cause of his stress but I would let him know and he would call if he felt that appropriate (he didn't, he said if he wasn't feeling so down he would find it amusing that they suggested that after seeing him break down when they refused to give help).

Bulletpoints yes!-I have already given him a small list of things I think are important to mention but not his defined symptoms, I will add that and talk to him to make sure he has it clear. Don't get me started on the taxes thing!I respect (good!) medics with all my head and heart but I have used that line when he's in the past defended them!He defends everyone, he's so nice to everybody apart from himself.

He does have depression, also swings of psychosis ,talks to himself and shouts and gets angry although never with other people only himself. Doesn't sleep for days...Repeats himself a lot... I want to help as he helped me through a lot of my problems a while back and he's very dear to me, hence why this situation is driving me nuts.

I do feel let down by this GP but luckily,last time he required a sicknote a new doctor at the same practice called him to discuss it and he had a nice talk with him and he says he would feel confident listening to that particular doctor. Fingers crossed!
And thanks again :)

[SilverStars]

Yes if he gets a diagnosis from a private psychiatrist and that psychiatrist writes to his gp stating diagnosis and medication recommended the gp then is asked to prescribe!!

A diagnosis stands. If the gp disagrees with a private diagnosis it is up to them to fund a second opinion on the NHS. I just thought if he was going private for counselling a one off fee, for an hour appointment with a private psychiatrist may be an option. You do not get as long with an NHS dr and it may suit your friend to be comfortable enough to speak and get things sorted quicker?

[Sunflower49]

It's a very good option and I feel ashamed I didn't think of it before!
I am going to ask him what he thinks, and then try to find a private psychiatrist :)
He pays weekly to see a counsellor at the moment so I don't see it being a problem if he likes the idea.
Thank you, have some SS and NN :)

[SilverStars]

The counsellor may be able to recommend a private psychiatrist or direct your friend to a few. Private hospitals usually have private psychiatrists as well if that helps.

[Sunflower49]

Thank you-I'm a googling right now!

[Sunflower49]

Another question -sorry!
IF they do refuse a referral, what can we say?Can I say we will go to a governing body or something?Is it the Care Quality Commision?

I ask because a)we haven't been able to get an appointment. I and he both began telephoning to GP (separately )at quarter to 8 (they open at quarter to nine) couldn't get through, their automated system not working and when we finally got through (well he did) was told they were full. We have to try again on Monday.
And b), I am struggling to find a local private psychiatrist :(

a) isn't giving me much faith in them so I'm worried again.

[SilverStars]

It will be difficult to get a gp appointment this past week or even next week as most would be closed due to bank holidays and therefore will have lots of people wanting one. Also do not know what the gp system there is like but if urgent illness we get seen straight away or if not urgent usually a 2 week wait. Especially in winter months!! So although frustrating can understand it will be full today. Worth a try for Monday even if have to wait to get one!!

It is the CQC yes that all gp's are under now.

For private it depends where you live. Are you near any major cities? If so they will have private hospitals. I just found my nearest Nuffield/ Bupa hospital and clicked on their find a consultant list and found a choice of 4 psychiatrists to choose from. Could you do this? Even an hours drive for an appointment should be ok?

[RubyRR]

Have you tried looking at a local private hospital, usually they have visiting psychiatrists a few days a week for appointments.

[Sunflower49]

Thanks Silverstars-I finally managed to get him an appointment today although not with the GP he wanted to see as he's off until Thursday.

He needs a sicknote for work so we really cannot wait that long, plus who's to say we'll be able to get an appointment on Thursday :(

The receptionist wasn't very helpful when I tried to explain that their automated system wasn't working, spoke over me (again asked me a question and interrupted me when I began answering it.

I know this GP we're seeing today was the one who refused the meds last time :(

Anyway, my plan is to go in with him, say we need a sicknote and a referral.

I plan to say that his counselor and support group all agree that he needs to see a psychiatrist.

And I plan to get him to reiterate his symptoms.

Please wish me luck, I'm actually feeling very anxious myself, now! This'll be me as well if this carries on lol.

I'm looking at our nearest large city for private hospitals and psychiatrists now just in case. Thank you again all, for your help.xx

[Sunflower49]

Also he's so stressed out with this that he's currently crying and unable to string a sentence together.
I think I will have to do all the talking, whether that is going to help us at the GP or not...

[SilverStars]

How did it go?

Any luck with finding nearest private hospital and names of private psychiatrists working there?

[Sunflower49]

It worked!

The GP was sympathetic, listened to us both, referred us for both private and NHS psychiatrists and talked us through some other services.
I'm not sure if one aspect of our behavior in this appointment worked, or if the GP was feeling more helpful this day, or if something else-but things went well!

Thank you so much, everybody who has replied. I'm sure what I have learned here played a large part.

We've seen a private psychiatrist and will see the NHS one tomorrow, to decide which the best option-obviously if the NHS one seems good it would be better, he has a good job but nobody likes to spend £ if they don't need to.

There was a lot of apologies from the GP,and he asked me to detail everything that had gone wrong to enable him to look into it.
Feeling much better now, and more importantly, so is my friend. :)

[SnowyMouse]

That sounds great, good luck.

[SilverStars]

That is great news. It is quite unusual to see an NHS psychiatrist so quickly. Can you get him to ask the psychiatrist how often the psych will see him, how long between appointments ( usually once diagnosed only see for medication reviews on NHS so 6 months or so is common and for 20 mins a time), so he gets an idea of treatment. Also usually see a consultant and their team in NHS so worth asking about this as not always the top person seen. Sorry just thinking about useful questions.

Hope between these 2 psych's he gets a diagnosis!!

Agree if do not have to pay even better.

Hope some medication is forthcoming too!!

[Sunflower49]

Thanks Snowymouse x :)

I agree and thanks for the useful points, I'm hoping to go with him tomorrow actually, and no need for sorries, you've been very helpful!

I think It's Bipolar disorder to be honest, the private one we saw yesterday didn't actually diagnose as it was a free assessment, but he did say that's what he comes up with from the questions he asked and the discussion.

The GP said it would be very quick to see a psychiatrist, if this is unusual then hopefully it was because he thought 'Hang on I've been pretty crap here, let's sort this out!' lol.

I will ask for details on treatment. Thanks again all, It's very frustrating when you're watching someone you care about in this situation and nobody seems to know what to do, and I have got more help from Mumsnet than from anywhere else and believe me I've tried!

[Sunflower49]

Okay the NHS said there's a 6-8 week waiting list to get treatment :(

I really don't think he can wait that long.

The private psychiatrist have said they'd need him as an inpatient to monitor the medication although they also have said in the past that he could be treated as an outpatient. Inpatient treatment ranges from £6,000 to £13,000...I'm not sure he can stretch to that (or would want to)!

So I'm kind of back to the drawing board-going to do what SS suggested and look again to the nearest larger city and see if I can find a different one and start again.

The GP did say Bi-Polar but I am assuming a GP is 'not allowed' to diagnose or medicate for that?
This is all so bloody complicated and stressful, It's making me really feel for people who are in his position (or worse!) and do not have anybody helping them at all :(

[SnowyMouse]

The private psychiatrist should work with you as far as inpatient vs. outpatient goes. Good idea to try a different one and see what they say.
For diagnosis you need more than one episode - you can read the NICE guidelines Quick reference guide here, page 6 talks about referral.

[SilverStars]

Hi I can assure you that 6-8 weeks on the NHS is very very quick, even if it does not feel like that. If you ask people on here most have to wait months just to see an NHS treatment and up to a year for counselling is not unusual. The NHS do not put people in hospital to monitor medication for MH diagnosis. This is very old practice! It can also make people feel "ill" if that makes sense. When diagnosed with many physical health issues people are not usually put into hospital to assess medication unless there is a clinical need.

No the gp would not diagnose serious mental health illnesses, just as they would not diagnose serious physical health issues usually.

Also I would say it is most unusual to have to be inpatient for private treatment, that just sounds like money making to me so I would certainly not want to see that private psychiatrist again!!! Certainly he would not be inpatient on the NHS just to diagnose and only inpatient if he is at risk of harming himself or others usually. When people are inpatient on NHS it is fairly basic, shared rooms, no talking treatment, see a dr for review nice a week. Better places may have OT's or recreational staff. But it certainly is not the rehab or priories you hear in the media. Some treatment centres are therapeutic but often with long waiting lists for places.

Personally I would find your own private psychiatrist for diagnosis elsewhere!! And go for a paid session, not a free one so get treated and medication request sent to gp ASAP as if bipolar medication is usual route. And then wait for NHS treatment to kick in.

But the NHS seem quite pro active where you are really, as 6 weeks is really short for any NHS treatment to start. Remember if he is actively suicidal and needs urgent treatment to get him to A and E or a dr straight away; this will not bump him up the list for mental health treatment long term but will ensure his safety until his local team can see him.

[SilverStars]

Sorry should add the NHS should see everyone within 18 weeks of referral so it sounds like you got a quick temporary appointment to check he did not need sectioning or was at risk of hurting himself or others and he got triaged as needing MH treatment and the team that will do that can see him in 6-8 weeks. Whereas most people get referred by their gp and wait 6-12 weeks just for the initial assessment.

If it helps, even people with cancer diagnosis only have to be seen by 2 weeks.

When my baby son was very ill we were referred to an NHS paediatrician for diagnosis and treatment and had to wait 17 weeks for this. This was after several necessary trips to A and E ( sent by gp).

He can phone Samaritans anytime or text them to chat which can be useful. Also having a routine or a plan as to how to manage his time when signed off work can help, just little things. Getting up at a set time, good sleep hygiene, people to see etc may be helpful. Or is there any family that can visit?

[SilverStars]

The referral times to MH are the same as to physical health teams - guidelines say you have to be seen in 18 weeks. They can put people under crisis teams obviously if needed before then, but that is a different team to the usual MH teams. The only difference is if someone is pregnant - they have a time of 4 weeks to assess, due to possible issues with the baby.

It used to be much longer than 18 weeks, but since Government put different rules in place no one has to wait more than 18 weeks. This does not mean a patient then gets immediate long term therapy, or inpatient treatment, or anything like that -there are long lists for such treatments, but it means they are assessed and put onto waiting lists for a place on a treatment program, given medication, may be referred to be under a CMHT, referred for CBT etc, or be under a psychiatrist for diagnosis or medication reviews.

How is your friend OP?