'Doncaster patients waiting too long for mental health diagnosis, and A&E fail to understand the issues'
Patients can wait too long for a mental health diagnosis in Doncaster and emergency facilities can fail to understand the issues, it is claimed.
But health bosses have revealed how that could change with new support for people with mental illness as an alternative to A&E.
Our panel at the NHS’s Woodfield House, Balby, was: John Bottomley, associate medical director, Rotherham Doncaster and South Humber Healthcare Trust; Rupert Suckling, Doncaster director of public health; Annika Leyland, mental health social worker, Doncaster Council; Lee Golze, head of strategic commissioning and transformation, Doncaster Council; Stephen Emmerson, head of strategy and delivery, adult mental health, NHS Doncaster Clinical Commissioning Group; Andrew Goodall, chief operating officer, Healthwatch Doncaster; Melanie Hinchcliffe, GP, Lakeside Practice, Askern; and Glyn Butcher, Wendy Robinson and Amanda Pratt, all peer ambassadors, Doncaster People Focus Group. Free Press community engagement editor David Kessen chaired.
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What problems are we seeing in mental health at present?
Amanda Pratt: “I’m nearly 40 and was first diagnosed with depression at 17. Then I was diagnosed with a personality disorder, anxiety and depression when I was 36. I agree there are concerns over waiting times.
“It was a long process for me to get my diagnosis and it was not straightforward. I went to my GP. They referred me to a psychiatrist, and one said one thing and the other said another. I found it was batted between services with no one really taking responsibility. It made the whole process, when I was very mentally unwell, much more difficult because I was trying to find answers. It took a good couple of years or so before I ended up getting my diagnosis.
“I did find there were people within services who listened to me. But I didn't feel I was treated as a person. I didn’t feel what I was going through was taken seriously.
“On one occasion I presented myself in A&E. A&E is not designed for someone with a mental health condition. It is designed for someone with a physical health condition. You sit there and you've already got anxiety. You're there for several hours in a room which isn't particularly pleasant.
“I was faced with someone who wouldn’t take me seriously because I’d been able to get a shower, wash myself, dress myself and present myself there. Stigma needs to be broken down with some staff that work within the NHS because they’re feeding that stigma, with the idea that you can’t have a mental health problem if you’re clean and well presented and can speak well.
“Most of my anxiety is hidden, very much internal. Looking back on my experiences, I’d like to see staff genuinely listening to someone about their needs, not dismissing them, and making them feel what is said is taken on board.
“They're not there to fix everything and no one has a magic wand. But for me, particularly when I was reliant on services because I didn't have family and friends or support, they were the people I was turning to, but I was feeling not supported.”
Stephen Emmerson: “In terms of what's a suitable environment for someone being assessed and identifying their needs, I agree that A&E is not that right place. We are now putting something in place so we will have alternative places where we can asses a person's need, that are not based in very busy A&E environment.
“A&E is not conducive to supporting that individual, de-escalating any stress and crisis, and getting to the bottom of their needs. We've made a significant investment in more crisis resolution resources, a psychiatric decision unit and more resource in the acute trust as well.
“That will start working through this year, and we expect to see big changes from that. There is a change of direction of primary care networks, and part of that is about bringing in community services and working within neighbourhoods and primary care so there's a better connection and support within a broader sense of a team that is focused on the neighbourhood. It is starting to build that bridge and make that happen.
“Anything we do from hereon in terms of development will have to have a sight on what it means for joining services together and working in partnership.”
Rupert Suckling: “I think wrapping services around communities has to be the way to go. One of our challenges, particularly around mental health, is the training many professional groups have had. They used to say you could become a GP without doing any psychiatry after you graduated.”
Melanie Hinchcliffe: “Whatever training you have in psychiatry may have been as a medical student or in your foundation years so its not necessarily the case that all GPs have done psychiatry as a job.
“But I'm really excited about the networks, being one of the most northerly surgeries. My patients don't have easy access to the town centre. They tend not to like it and won't come down. I don't think it’s anything other than the fact that geography means we're so far north that patients won't go down to A&E and I think its the same for mental health services. The new networks are great for us
“We’re going to have a north network and we're already looking at what's in our neighbourhood in terms of community services, and there's going to be funding for social prescribing. I think we have that already but there is going to be additional funding available for it and we will look at how we can use it in our communities.”
AP: “I received help through social prescribing, so if more money is being put into that, I think that is a good thing. I had never heard of that before my doctor put me forward for it. It was invaluable I think it’s to be encouraged.”
David Kessen: “What does that involve?”
MH: “It is when we do more low level community things around loneliness, counselling, support, access to services. I went to our local library and there's a lady there trying to set up a mental health group. There’s is literally just one lady there. No else else is going, and we can try to signpost people, but there is the difficulty of stigma and getting people into these groups.”
John Bottomley: “You may see a range of different people, who contribute to care, and that's great that you see lots of people with lots of skills. There is lots of resilience in the system, but they don't have a one stop shop.
“There is a range of different services from different organisations, but there is a perceived disconnect. You may be talking about someone's medication but they may they have problems with their finance, or their housing, and a doctor can't solve that. Social prescribing comes in there.”
Andrew Goodall: “I think the focus is on organisations, which separates it from the communities that live in those primary care networks. I know the primary care networks have only been around for a month but it would be great if we could change the name from primary clinical networks to primary community networks that focus on communities they service rather than organisations.”
Glyn Butcher: “The communities’ priorities are not always the same as the institution's priorities.”
AG: “I think it is a real plug for listening to people who access services and carers.”
Wendy Robinson: “I tend to put everything on myself. There is nowhere to go to help me as a carer. My mental health can go down the pan. Carers just have to get on with it.”
SE: “There is support through the patient focus group network”.
GB: “One of the worst things devastating our communities is Universal Credit, and part of this investment in communities needs to have computers in computer hubs to allow people to do the online assessments.
“You’ve got people who've never used a computer in their life and its affects their mental health. I think it’s the tip of the ice berg. People don't know what to do.and they've had their money taken away.”
What are the most common mental health issues we see in Doncaster?
GB: “One of the new buzzwords is unstable personality, what used to be called borderline personality disorder. It seems to be a diagnosis people are getting a lot.”
RS: “Depression, anxiety and a mixture of anxiety and depression are still some of the most common things we see in adults. Half of all mental health disorders we see are among children, including conduct disorders. Many mental health disorders you see throughout life occur early on in a child's development.”
JB: “If one in six is the figure, we’d expect around 50,000 people in Doncaster to be suffering anxiety or depression. We've got about 3,500 suffering from dementia in Doncaster. That's significant. We’d expect about 300 people in Doncaster to have a major psychotic disorder like schizophrenia.”
GB: “One of the major things people are using now is gambling. We have ambulance workers, doctors, social workers, every profession under the sun. Now one of the symptoms is people losing their homes and families.”
Lee Goltze: “Poverty, funding, gambling, exercise, there are a lot of wider social economic factors affecting people’s mental wellbeing.”
Annika Leyland: “In terms of observations from front line practice, we’re seeing an increase in drug induced psychotic presentations. We're assessing more people in crisis, particularly under the mental health act where there's been a significant incident, crisis where there's been risk to self or others or police involved. It has been a variety of different illicit substances.”
JB: “The incidents of detentions by police has more than doubled so we know there is a high incidence in Doncaster of people in crisis being seen by police.”
RS: “Some of the work around complete lives is starting to work. Currently that focuses on the 120 people who are most at risk. One of the challenges is how we expand that to those who are at risk of falling into that group.”
JB: “The kind of major mental illness that psychiatrists fix and treat is not particularly different to how it was a decade a go. It is the adversity that people are grappling with social adversity and difficulties, and poor coping and people needing support. It's not something you fix with a tablet. It is broader support that needs to be available.”
GB: “I think one of the greatest successes in Doncaster has been the Safe Space scheme.”
SE: “We trialled that through the winter period. it is an alternative vision, a peer led service operated by PFG, Mind, and Open Minds and Changing Lives. It was somewhere else where we might be able to direct effort to stabilise that immediacy of presentation but work with an individual about understanding needs and being able to connect that individual.
“We work with different organisations with a support network that will make a difference for them, and connect them with what's going to make a difference for that individual. We tried that through the winter period, and tried it again when we went system perfect, trying to work with the emergency departments in the acute trust and mental health trust.
“There were some really powerful messages that came out from that about what would have happened without that support there and how we would have had to rely more on the acute care system than would have been appropriate, and would have delivered different outcomes.
“Now we’re trying to find a solution to get a sustainable delivery for Safespace moving forward. We've bid for some money to do so and we're just waiting for that to be announced. It will be supported by the NHS and socialcare, very much linked with wellbeing officers as well, but it will be a peer led service around supporting that individual, stabilising and connecting.”
What has been the best success story that you've seen helping someone with mental health problems?
LG: “From a children's point of view, over the last three years we've introduced a community treatment service which is mainly for young people with a high level of need around acute mental illness and likely to therefore get them into an inpatient bed.
“Two years ago Doncaster was an outlier in terms of the number of children admitted and the length of time. We have since it came in seen a seven per cent decrease in the number of young people who have an acute mental health need that are admitted to a hospital ward.”