It has been a few years since The Cockroach Catcher retired and in that time, the landscape of Child & Adolescent Psychiatry has changed. Can CAMHS survive the storm like the pelican?
Without much public notice, much of this sub-specialty has shifted into private hands. Just around half the last time I looked. Now there is talk of looking at CAMHS with the offer of money! Wow! Or was the outcome going to be: lets sell the profitable parts of CAMHS such as Anorexia Nervosa and leave the rest! i think I know what it would be. Just look at Dermatology!!!
And it may indeed be true that more money is pumped into CAMHS as outsourcing ignore one big factor: privateers are there to make money and NHS cannot get out of the contracts and ended up paying more. Look at outsourcing social services.
Dermatology shows how NHS being decimated
By Dr David Eedy, President of the British Association of Dermatologists - 15th December 2014 11:24 am
The news that a third of NHS contracts in England have been awarded to private sector providers since the service was reorganised in 2013 is a fact that dermatologists and their patients are all too aware of.
In fact, some estimates put the figure at 70% of NHS contracts going to private providers in just the first year.
Dermatology is a prime example of how government meddling is decimating the NHS, despite the fact that each year, 54%of the population is affected by skin disease, and 23 to 33%of the population at any one time has a skin disease that would benefit from medical care.
I have personally dealt with "gaming" by private insurers. Now, it looks like the gaming is over as the payer is the NHS. You only need to look at the papers to realise that Anorexia Nervosa in particular is a growth industry. They are difficult to treat, recovery is not guaranteed and when the payer is the NHS: WOW!
As the sun sets on our beloved NHS:
©Am Ang Zhang 2012
Perhaps it is not that well known that the dismantling of our beloved NHS started long before the present government and the future does not bode well for those of us that likes to keep NHS in the public domain.
Child Psychiatric in-patient units across the country were closed some time after many adult hospitals were closed or down-sized.
To me, the government is too concern with short term results that they impose various changes across the board in Health Care & Education without regard to the long term consequences or costs.
After all, I have made good use of in-patient facilities to un-diagnose ADHD and that would in turn save children from unnecessary medication and the country from unjustified benefit claims.
Such units were also great training grounds for the future generation of psychiatrists and nurses. Instead, most rely on chemicals to deal with a range of childhood psychological problems.
Indeed it was a sad day when the unit closed.
From The Cockroach Catcher:
Chapter 48 The Last Cook
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ne of the few things I learned working in some inpatient units was to be appreciative of the ancillary staff. What a cleaner might reveal to us was often more telling than a formal interview. It could well be that often parents were unguarded and more able to reveal things to someone like the cleaner or indeed the cook.
I was fortunate enough to experience one of the last NHS cooks when I was Senior Registrar at an inpatient unit. The inpatient unit catered for a middle age group spanning the older children to the younger adolescents. It was one of a kind in the U.K. and indeed it was the first to start a national training course for Psychiatric nurses in inpatient care, a good three years before anywhere else.
The unit was in the middle of town and was considered to be too far from the Hospital for catering purposes. Instead a cook was employed to cater for the needs of the children and nursing staff. We doctors were not supposed to eat there. But we did. Mainly for lunch.
If we arrived at mid-morning we used to get a nice cup of tea. But that was only since I started bringing in my own tea leaves. We also got served home-made scones and the like.
All very homely.
I had since wondered if our great success rate was more to do with having our own cook than all the other therapies and tit bits that we did.
You never know as people do not really research these things.
……I often arrived late at lunch time after the children and nurses had eaten as morning clinics had a habit of running late. With less than ten minutes to spare, the cook would still manage to serve me a bit of some of the things she knew I preferred. Often she felt compelled to sit with me to tell me about her grandchildren or about what the government should really be doing to help the likes of her, a war widow bringing up two sons in this Naval town. I always admired the resilience shining through her stories.
She also provided me with her down to earth views of what we should do with whichever patient that had come in. I listened. I took note. You never know.
Sheena was the mother of two girls we had to admit. They were both ‘soilers’ and they would never touch vegetables at home or anywhere.
Sheena was petite, worn and a chain smoker.
But she had two lovely looking girls.
We knew from the start there were handling issues and most likely diet ones too.
One of the other reasons for their admission was that by and large there were very few girl ‘soilers’.
It was always a good sign when a child flourished in an inpatient setting, and away from home some mothers were more capable of telling you more of what went on. Some mothers found it easier to talk to one of the non-medical staff, perhaps the cook.
Mothers got fed too on their visits. More often than not the children preferred their mother to go home than to stay and watch them. That was a different issue. With the money spent on cigarettes and drinks not much was left for food either for the children or the parents. I knew that if we checked for vitamin and other deficiencies we would find them, a problem that had taken Public Health a long time to wake up to. Increasing tax for cigarettes and drinks did not change people’s habit one little bit.
With a simple routine the girls were clean in no time. At least during the week as they all went home week-ends, when the unit was closed.
We were at a loss as to what was going on.
The girls would get worse over the week-end and soil. This went on for quite a while.
Then one day the cook talked to me.
“Sheena never stays Mondays,” she told me.
I listened.
“Have you noticed she is always in dark glasses on Mondays?”
How stupid of me. Now and again I saw her at the door seeing the girls off and yes, she wore huge sunglasses.
Sheena was not a movie star.
I arranged to see Sheena.
She said, “You knew.”
I nodded.
“But I cannot leave him. I have nowhere to go and I shall not get enough benefit money if I am divorced from him. He now goes to the day hospital. Fridays he gets drunk and beats me up. It is like a routine. I try not to get hurt and hide it from the girls. If I walk out, he will find me even if I have somewhere to go. I shall still get beaten up. Now at least I know when it will happen and I can live with that.”
I suggested that I should speak to him but she looked terrified.
She felt he might even kill her if I did and last time he threw a chair at a male nurse who tried to say something.
She was probably right. We often had no idea what people and particularly women put up with. It would be too easy for us to bulldoze in. We had to think twice before intervening unless we had something better to offer. His Schizophrenia diagnosis allowed for a higher level of benefit she would not otherwise get. Who would she meet up with next? Another violent man most likely.
Was it such a cop-out on my part?
Maybe it was, but in a strange way the girls stopped soiling after that one meeting I had with mum. The case left me with some unease - unease not just about what I did or did not do but about keeping patients in the community. Three other lives were affected here and who knows, one day he might go too far. That was before Maria Colwell.
The unit had long since been closed.
The last cook in the NHS retired .
