"Failure of GP/Practice to proactively engage with the needs of a high anxiety OCD/depression patient "
About: Devon Partnership NHS Trust Devon Partnership NHS Trust Exeter EX2 5AF Devon, Cornwall and Isles of Scilly Devon, Cornwall and Isles of Scilly Tiverton Hospital / Silverlea Community Mental Health Team Tiverton Hospital Silverlea Community Mental Health Team Tiverton EX16 6NT
Posted by ExtremelyConcernedRelative (as ),
(1) Patient needs:
This story relates to a patient who has struggled with blood/germ/contamination OCD, for near on 30 years, at present is subject to SSRI drug medication, yet desperately needs Hi-Intensity CBT treatment on a regular (every week, or every two weeks), consistent (same day/time and at times suitable for the patient, due to children/school attendance commitments), and over an extended period (30+ if not more sessions). This is typical of the needs of patients who suffer with medium to severe OCD, and for which any CBT Therapist needs to have OCD specialism. Generalist CBT is often completely inappropriate/ ineffective!
(2) OCD triggers & consequences:
To the patient, anything that looks like blood triggers extreme anxiety, with often comorbid spells of low mood progressing into deep depression and even thoughts of suicide at their blackest moments. These triggers can be anywhere, but are often to be found at local GP surgery, hospitals etc by their very nature. This person cannot therefore freely (except under considerable duress/stress) attend consultation/clinics/sessions in those locations, because their OCD makes it near-impossible/difficult to do so. Further, patient thoughts of anyone visiting her home from a GP, hospital base, or other setting which is perceived to contain blood or mail arriving in the post with blood/red stains or marks on them, catapult the patient into high/severe anxiety, with consequent weeks thereafter of being unable to face/deal properly with the needs of daily life. Stress (caused by any number of reasons: lack of treatment provision; failure of treatment providers to engage with patient adequately, or even at all; harassment by health visitors; constant need to continually pursue rviders) is also a major exacerbator, and compound to increase patient anxiety with consequent severe to near-critical outbreaks of OCD.
(3) Recent failings of Devon based mental health treatment service provision:
In the spring of 2013, referred by Midwife services based at Tiverton & District Hospital (TDH), patient became engaged with Perinatal services centered in Exeter, due to her SSRI medication and OCD, and received excellent service from them, with constant engagement from staff concerned with patients progress. Post-natal from late-summer/autumn, patient then became referred onto the East & Mid Devon Depression & Anxiety Service (EMD-DAS) (albeit that this is a low to medium DAS! ), another of the Devon Partnerships NHS Trusts' (DPT) mental health treatment services for Devon based patients. Whilst CBT sessions started, they quickly stopped (3 sessions only achieved), due to a mixture of Therapist unavailability and EMD-DAS scheduling appointments without any recourse to the patient, and at wholly inappropriate/unattendable times, which patient found it necessary to cancel! Since November 2013, patient has frequently contacted EMD-DAS, in order to resuscitate her treatment, only to be continually told, that Therapist or the Clinical Lead would return her call, but now 3-months later no-one has ever called. It is clear, the patient has no Recovery Coordinator in contravention of DPT's own C05 Wellbeing & Recovery Policy, nor any person, team or day-to-day operations DPT-wide, that are Proactively focused on this patient/service-user!
(4) Recent GP lack of positive action:
With the patient now having reached complete despair with DPT and its lack of action, patient last week turned to her GP seeking alternative sources of her treatment. In consultation, it was evident to patient, GP was only then reviewing her case, was unaware of who had previously referred patient to DPT services, appeared not know or be aware of CBT sessions that had been cancelled/missed, nor of knowing anything about EMD-DAS's continuing failure to reinstate patients CBT. Further GP proffered no information (appearing not know) about alternative sources of treatment: either within Devon or outside; NHS or non-NHS; via online psychological therapy delivery mechanisms or otherwise, so as to meet the needs of this OCD patient, nor even demonstrated the slightest desire or willingness to consider directly referring the patient elsewhere. GP advised they were only able to refer patient to the local Siverlee CMHT (another DPT service, but one that is centered in the adjacent TDH). That advice was further qualified by, patient would then have to wait (further delay) for their Silverlee consultation and after that there would be yet more delay, as anything the patient became referred onto, would itself have a considerable waiting list time. Thus a clear realization by GP and open admission that Devon does not at present have the treatment provision that patients need, and in OCD anxiety cases, such as this patient, the treatment provision as so clearly articulated in NICE CG31. Rather than being helpful, patient was in greater despair following GP consultation.
(5) GP/Practice failings:
Patients who struggle with mental health conditions are by the very nature of their conditions Fragile at the outset and by all definitions Vulnerable. In general they will not and often cannot (freely) come knocking at GP Practice doors. By default, every GP/Practice should be sufficiently knowledgeable and be-acutely-aware of this, and act accordingly. As a consequence, pursuit of patient Health, Wellbeing and Recovery can only be achieved if the GP/Practice continually pursues Proactive and ongoing engagement, treatment, review and monitoring of such patients, inclusive of all patient experiences in any/all referred-onto services. To do otherwise, is tantamount to patient Neglect, and everyone recognizes what Neglect of a Vulnerable adult constitutes.
Patient became registered with Practice early in 2013, upon returning to Devon. Following registration, no evidence that GP/Practice properly reviewed patient medical notes upon initial receipt, took 5 months to write to patient, and then only offered Reactive support. Throughout GP/Practice has failed to address the ‘whole person’, not demonstrated any proper patient advocacy, nor shown any apparent willingness to rigorously engage with the NEWDevonCCG, or other means (including out-of-district) of commissioning the treatment provision that this patient so badly needs, and needs NOW, not at some hopelessly vague point in the future.