Friday 31 December 2010


I'm surprised!

The readers of Mental Nurse have voted for favourite mental health blogs and have voted for this as their favourite Psychiatrist's blog.

Given the number of popular psychiatrist blogs, more established ones, more frequently updated ones, newer ones, more evidence based ones and almost all of them look nicer/are better presented, and more popular blogs (with me tumbling through 2010 from number 2 to number 15 now) I'm very surpised (and of course pleased) that folk rated my musings.

So, a big thank you for being so kind!

Now, get on to Mental Nurse and rummage around some really good top quality blogs!

Liaison Psychiatry

It's stopped.

Bank Holidays must have something to do with it. I can't really fathom it, since that local acute Trust has a massive pressure on beds and is keen as mustard to move patients on.

Yet despite having hundreds of patients within their hospitals who've dementia, delirium and major mental illness, spread over a number of sites, with difficulty in managing and effecting safe discharge for these patients, I've not been swamped by liaison referrals. They've literally hundereds of patients with mental health problems on their wards. Often they find them very very difficult to manage on the ward and to plan discharge for. What with capacity assessments, Best Interest Meetings, Continuing Care needs there's usually process they want support with, before we even get to advice on clinical care.

With pressure on beds you'd expect there's be squillions of referrals to my door, trying to speed up the assessment, diagnosis, management or discharge planning for these patients.

Over 5 consecutive days I had 0 referrals. Not one. We usually have referrals every day. It's utterly unheard of.

Long 4 day Bank Holiday weekends. My fear is that no routine or important work gets done, only urgent/emergency work's attended to. These patients with physical and mental health needs, within the acute Trust, have unusually had no Liaison Psychiatry input in to their care for almost a week. Junior doctors and on-call staff haven't been considering their mental health needs and referring for specialist input.

Bank Holidays seem dangerous. This surely can't be good for patient care . . .

Tuesday 21 December 2010

Mental Capacity Act 2005

I'm blessed with fantastic colleagues. It's really the only reason I'm working where I am. The staff really are fantastic.

Colleagues outside of the NHS are more variable in their competence. Some social workers are fantastic. I've a lot of time for social workers, they do a hard job with little meaningful support/team work. One disadvantage of this culture is that social workers are pretty idiosyncratic animals. They all work differently, with sometimes very different attitudes and consequently very different interventions (or lack of interventions).

This variability in social work bemused me . . . shouldn't it be a needs led service? Shouldn't what the patient (erm, client, to them) needs define what activities the social worker undertakes/the content of their care schedule? No, it all falls down to the quirks of the individual social worker (or assessment officer) in my corner, and the attitude/whim/habits they possess. Patients get very different responses and outcomes depending which area team social worker picks up their case.

What's more muddling is their response to change, including legislative changes such as the Mental Capacity Act 2005.

A social worker today said they didn't know it, she hadn't had what she thought was enough training on it, she didn't use it and it was "still new" so it didn't matter. 3 of her colleagues thought similarly. New? Still new?! It was drafted in 2005 and implemented in 2007, we've been using it for years!

Good grief.

But those individuals ignore it, don't do formal capacity assessments or Best Interest meetings/decisions or the like. Instead they refer such nonsense to their Team Leader (who has to do it all) because when she says they have to do it, and it's the law, they just tell her she's, "going off on one, again," and shrug and move on.

I'm not sure we've the ideal system, locally, for embedding current best practice within Local Authority social work teams . . .