Sunday, 23 August 2009

Private Psychiatry

People dabble in private practice, within the mental health arena. Patients seek solutions outside of NHS care, especially if care's shabby in their corner. Practitioners ply their trades, cross their palm with silver to receive whatever benedicition you desire.

Mostly it's innocuous stuff. A nurse charmingly nailed it when she said it's all a bit like internet porn, everyone knows it's going on and is somewhat unwholesome, it's pervasive and there in the background, but it doesn't change day to day life that much.

I don't do any private work. Partly it's because I simply don't have the time to do so. Mostly it's because the NHS can do it better.

A lady with a bereavement had input from us a few weeks ago. I saw her 3 times in one week, my nursing colleague saw her every day, for an hour, doing CBT. A support worker's since got her out, shopping and swimming and baking and doing again. She had a few days as an in-patient, under my care, when things were bleak. For 5 years she's been housebound. She's had a fair investment of care, over a couple of months.
- I got the referral from a GP on a Friday afternoon, rightly worried she was suicidal. She was seen by me, a Consultant Psychiatrist, at home, that afternoon.
- I saw her twice the next week, visiting to talk with her and her husband, whilst fiddling with tablets, formulating with them and looking at what she wanted to do to cope better
- She's been seen by an OT, looking at getting out to do more, in a purposeful and meaningful and pleasureable way, rather than just doing more
- She's been seen by our support worker who takes her out and goes with her to tea rooms, filled out forms with her, got her back to feeling okay in practical day to day tasks
- She's had input from a Consultant Psychologist who's not seen her but has given advice on her care and CBT that's undertaken
- She's had indirect input from our pharmacist too, discussing her medication with me
- She's seen by a CPN a lot, from subsequent joint visits with me to daily input for CBT to weekly input

Two months on she's strikingly better, will it last? Time will tell.

Could she have received better care, privately? No. Could she have received comparable care within the private sector? Not within my patch, or within the adjacent cities or counties. Episodic input titrated to need, indirect care contributing to the team working, flexible care across in-patients/community, care in clinics/at home (depending on what she wanted her family to hear), joint working, daily input from different qualified/unqualified professionals, rich and meaningfuly input from numerous individuals all effecting change in her care, collaborative working without a medical or nursing or psychological model dominating.

Community Mental Health Teams get a lot of stick. Sometimes rightly so, I'd not want to be a working age adult in receipt of our Trust's services. But when they get it right, it's in incomparable.

The NHS then far outstrips other provision of care.

It's good.


Zarathustra said...

Community Mental Health Teams get a lot of stick. Sometimes rightly so, I'd not want to be a working age adult in receipt of our Trust's services. But when they get it right, it's in incomparable.

This is equally true of CAMHS. My local CAMHS provision is excellent, and beats anything offered by the private sector. However, in some areas not far from me, particularly in some of the more rural locations, there's barely a functioning CAMHS service to speak of.

Alison said...

I’ve been under the NHS for about four years seeing a fair few different Psychiatrists and I can’t really fault any of them but I wasn’t getting what I wanted and that was mood stabilisers because I was certain it would help improve my mood swings but despite keeping mood diaries and explaining things all the Psychiatrists I saw were convinced I didn’t need them.

In the end I went private to The Priory in March and after my first appointment which lasted an hour I left which a prescription for Topiramate, five months on I am still talking it at a dose of 200mg daily along with Venlafaxine 150mg and the difference in my mood swings has been amazing. The Psychiatrist chose Topiramate because she thought it would help stop my binge eating and she wasn’t wrong. My appetite has changed considerably, I no longer eat half as much, don’t binge and have dropped 2.5 stone. My mood swings have slowed down significantly.

Going private was the best thing I did, both my Priory doc and NHS doc communicated well with each other when I was admitted to hospital as well for three weeks in May. I’ll remain with the Priory doc for as long as I can keep finding the money to pay the bills! ;)

The Girl said...

It is interesting to hear the way things work in your system.

From what I hear, in Australia most psychiatrists are private, as are most other specialists and all GPs. I suppose they could liaise with the others treating the patient, but the level of care would be unlikely to approach anything you are talking about here. It sound excellent - no wonder you love what you do.

XE said...

It's very interesting to hear about how the NHS operates, and how things differ and are similar to the Canadian system. Certainly seems like the psychiatry teams can be quite formidable!

Louise said...

Not in my experience.

Scream said...

So pdocs in the UK make house calls? Wow! That's wild.

fade_to_black1 said...

I am in the throes of a mixed episode, a rather nasty one at that. Luckily due to some fast action on behalf of my private psychiatrist and depakote I seem to be over the worst, well i definitely am or i wouldn't be talking very coherently here. The CMHT where I am at uni are shocking in every way shape or form, my GP says she is at her wits end with the service. At my agitated, incoherent worst early last week they requested that the crisis team be sent to me that day as they believed i should be admitted, but really wanted to avoid it. They screwed around rang everyone a million times, including me, and amplified the situation so i freaked out and ran away. My GP and psychiatrist pleaded with several people and all they could come up with is an appointment on the 19th, with a woman i have met before who has a pea between the ears and seems as if she is permanently dosed on benzos. My psychiatrist and GP have had to make do, they have rung me every day and seen me every other day, i would be dead without them. A team that works like yours would be amazing, i wish it were the same here. Where i used to live was much better, but certainly not ideal. My GP is lodging a formal complaint. Before i found this psychiatrist I had seen the local shrink once in a year and a half, with badly controlled bipolar. It led to me being shipped out to my dad in singapore for treatment in a shambolic, psychotic state with my future on my biochemistry degree hanging by a thread. THe same would be true now if it weren't for the private sector. I am a firm believer in the NHS and it breaks my heart that it is so often found so wanting, even where there are good and willing people.