Tuesday, March 9, 2010

NHS Psychiatry: What now?

Another suicide! This time of a young woman just hours after being discharged from hospital. The Daily Express reported:

“This was the first time she was willing to get help and had admitted herself two weeks before. But he claimed psychiatrists said that she ‘could not be helped’, despite her family doctor saying she was in need of urgent care.”

There is now so much concern about British Psychiatry that a recent post at Jobbing Doctor on the difficulty in getting a patient seen by a psychiatrist attracted some interesting comments.

In the past I was able to refer a patient to psychiatric services easily. We had clear delineation of roles. Psychiatrists saw psychiatric patients, psychologists dealt with psychological therapies, and counsellors did counselling. God was in his heaven and all was well with the world.

That was then.

Now we have a situation where we have a single point of entry into the system, via a CPN gatekeeper. How on earth they can make a proper judgement on the basis of one letter I am at a loss to say.

The current situation seems to be that a Multi-Disciplinary Team (in my patch this is nurses, psychologists and OTs) sit around a table all morning deciding what to do about referrals. Their entire raison d'etre seems to revolve around finding ways to avoid work. Any which way.                          …..more
And read the comments!

I have covered the problems of modern psychiatric diagnosis in: Psychiatry: A Floundering Discipline.

Is there a way forward? Yes, a cure!!!

Well, perhaps if we abandon the American DSM diagnosis, get back to more traditional European ones and concentrate on core psychiatric conditions as there certainly will not be enough psychiatrists to deal with the ever expanding diagnostic categories, and of course pay a premium for the few that would still do the job. That would mean dealing with severe psychotics that very few of the 'modern' 'TEAM MEMBERS' will want to handle.

And yes, bring back the asylums just like the ones they still have in France  (which is still reckoned to have the best health care in the world). That means abandoning community psychiatry before too many get killed at random or suicides that might be preventable. The only sure thing would be that funding for mental illness (not health) gets diverted to the legal profession.

It is a very sad state of affair.

Nearly a year ago, on the 200th birthday of psychiatry, the British Journal of Psychiatry published a letter signed by 36 psychiatrists, lamenting the downgrading of medical aspects of care in a “wake-up call” to British psychiatry:

“The recent drive within the UK National Health Service to improve psychosocial care for people with mental illness is both understandable and welcome: evidence-based psychological and social interventions are extremely important in managing psychiatric illness. Nevertheless, the accompanying downgrading of medical aspects of care has resulted in services that often are better suited to offering non-specific psychosocial support, rather than thorough, broad-based diagnostic assessment leading to specific treatments to optimise well-being and functioning. In part, these changes have been politically driven, but they could not have occurred without the collusion, or at least the acquiescence, of psychiatrists. This creeping devaluation of medicine disadvantages patients and is very damaging to both the standing and the understanding of psychiatry in the minds of the public, fellow professionals and the medical students who will be responsible for the specialty’s future. On the 200th birthday of psychiatry, it is fitting to reconsider the specialty’s core values and renew efforts to use psychiatric skills for the maximum benefit of patients.”                       ………More

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