Wednesday 26 September 2007

Mental Health

Mousie has kindly shared thoughts in comments here that an explanation of good mental health services was necessary.

I work in a mental health Trust that delivers, I believe, good mental health care. I've an appraisal in a couple months (a subject to blog about at another time) and part of the information gathering that managers undertake for this, generating an entire lever arch file full of objective evidence, shows exactly what I do and what the sector I work in as a whole is like.

- In the last 12 months every urgent referral from a GP has been seen within 4 hours.
- In the last 12 months every routine referral from a GP has been seen within 10 days.
- My access time for my next out patient clinic slot is under one week.
- In the last 12 months every patient of mine needing a hospital bed has been admitted immediately (with no wait time from blocked beds).
- In the last 12 months every routine liaison referral from medical/surgical wards has been dealt with within 5 days (some within an hour, most by the next day).
- In the last 12 months the number of patient clinics cancelled at short notice (defined as within 6 weeks of their appointment) : 0
- Average number of professionals involved : 3 (eyeballing it it's averaging a community nurse and me for most folk, with a social worker or occupational therapist or support worker or psychologist or memory clinic nurse too).
- In the last 12 months every patient discharged has had a letter written by me with summary including a diagnosis and risks and medication and interventions and follow up completed and signed before the patient leaves the ward, to be mailed to the GP.
- In the last 12 months every patient discharged has had a full discharge letter sent to the GP within 2 weeks.
- In the last 12 months every patient needing Mental Health Act 1983 assessment has been seen by me within 2 hours of the request (and only 2 of my patients have been detained).
- I've had letters of gratitude and praise, which of course is always welcome.
- I've had no complaints (verbal or written) about me or the service which in mental health seems amazing.
- Our Primary Care Trust gave extra cash to us this year (to offset the 2.5% "efficiency saving" the DoH forces on every hospital every year) because the PCT loves us. They let me prescribe what I want and aren't trying to limit drugs even when NICE are.
- meeting with GPs in the sector, they're strangely enthusiastic about our service and haven't had any axes to grind.

So everyone is seen within 2 weeks (urgent problems are seen that day), everyone can access a Consultant within 1 week (urgent problems are seen that day), all communication is prompt and there's good support from GPs and the PCT. The wards are new, every patient has their own room with ensuite, their own space and privacy.

It's not magical, it's just the sort of service I'd want for me, or my nearest and dearest. So that's the service we try and deliver. After all, who pitches up to work wanting to give a bad service? It's more satisfying for us this way as well as being responsive for our patients.

It's just to say that it is possible to have what I'd see as good mental health provision in the NHS.


PhD scientist said...

All sounds good to me.

I would have tended to assume the complaints about "good mental health services" that get play in the press relate to people with debilitating but "non-urgent" problems out in GP country.

According to my GP friends, where we are (N of England urban) wait to get seen by the primary care Mental Health team is several weeks to a couple of months for initial assessment by the Mental Health nurse. And the wait post that for counselling or for the much vaunted CBT is at least half a year, probably nearer a year for CBT.

The Shrink said...

I'd see that as unhelpful . . . waiting months is frustrating and often misses a "window of opportunity" to engage with and untangle a problem with the patient. Waiting lists are not necessary, so why have them? Best avoided, I reckon.

Hence the maximum of 10 days wait, in our corner.

PhD scientist said...

Maximum 10 days wait...? Crikey. Is that to see the psych nurse for initial assessment? Or an actual psychiatrist? Nurse, I'm assuming...

Would be interested to know just how much the waiting times for mental health services vary across the country. Three or four yrs ago our area used to have a 6 month wait-list simply to get onto the 18 month wait-list for CBT. It has speeded up a bit (see last), but not to anything like what you describe. I guess "urgent" referrals may well be prioritized, but the routine GP depression / anxiety stuff is definitely still slow hereabouts.

Would love to know if GPs in areas with long waiting times for Mental Health Team referrals hand out more SSRI prescriptions for depressed patients than GPs in areas with short wait times.

The Shrink said...

10 days to see either. As I said, my data and hospital managers shows I can see patients within a week in an outpatient clinic and nurses can see people within 10 days.

If a patient needs seeing we'll see them anyways, so may as well see them promptly and get the work done :-)

Calavera said...

Congrats on getting no complaints! (Written or otherwise!)

And I like your new display image.


julian said...

Assuming you're not willing to share the actual trust you work for, do you know of anywhere mere patients can go to get such information without filing a huge multitude of FOIA requests?

I ask not just because I'm interested, but because I figure if people consider the quality of bars and the like when deciding which university to go to, I'm not sure why I shouldn't factor this in for next year.

The Shrink said...

Julian hello there,

In truth any truly meaningful information isn't going to be accessible.

Details such as internal waits or delays in treatment or restrictions in prescribing or obstacles in team working (and a lack of a "seamless service") or deficits in funding or staff absences aren't going to be publically accessible details.

Service developments are often vague since many Foundation Trusts, necessarily operating as businesses, don't want competitors to see their hand before it's played out and established.

A few things I'd test out as a patient would be :
- Spend 5 minutes talking with (or typing a brief letter to) the Patient Advice and Liaison Service (PALS) to suss out the number of comments/compliments and number of complaints (which in our Trust and most Trusts is a public document published annually)
- Spend 5 minutes talking with (or typing a brief letter to) the Consultant secretary to ask what the waiting time is 'til the next clinic slot and whether you can request an out patient clini slot or whether it's the medics or nurses who determine that
- - Spend 5 minutes 'phoning (or typing a brief letter to) the local support groups (patient groups, carer groups, MIND, Age Concern, Alzheimer's Society, who ever would be relevant). They're often very savvy.

15 minutes information gathering then gives you a reasonable flavour (with objective and subjective elements) of what the service could be like.

Oh, and after that I'd rummage around the Trust web site which will be glossy and gloriously optomistic but at least will details components of the service and list elements that, again, may persuade or dissuade you from engaging with them.