"Referral gone wrong - Mental Health"

About: New Craigs Hospital / General Psychiatry Ross Memorial Hospital / General Psychiatry

(as the patient),

I visited a GP in the Ross-Shire area to talk about depression, anxiety and increasing suicidal/self-harming thoughts. This was not a new problem, and I had been seeing various professionals since I was quite young – although the only formal diagnosis I received was OCD and Depression.

The GP was kind and understanding, and made an emergency referral to the mental health team, which I thought was particularly good as sometimes GP’s just tell you to come back in 2 weeks and see how things are. This was on a Thursday.

I was amazed to receive an appointment with a CPN for the following Tuesday – in my many years as service-user I have never before seen such a quick response, even for emergency referrals.

I then saw the CPN for a number of weeks until my appointment with the Psychiatrist arrived. I was becoming increasingly suicidal, and the CPN kindly made a phonecall to the psychiatry department to see if they knew how long it would be until I was seen. I saw the CPN around 4 times before receiving my appointment with the Psychiatrist.

I was advised to take a family member with me as they like to interview them separately, which I had never heard of and was a bit uncomfortable with, particularly as I hadn’t lived with a family member for 4 years, but I was just grateful for the appointment, so I took my sister.

When we arrived, it was a trainee who was conducting the appointment. He spoke to us both for around 2 minutes, then asked me to wait outside while he spoke with my sister, who had to leave to go back to work asap. My sister then left and I was invited in. Although the trainee was fairly nice, the questions we asked were only related to OCD and to Borderline Personality Disorder – the trainee simply went through each diagnostic category and asked if I experienced it. I thought this was very much a crude way of measuring how I felt, and left no room for me to talk about my other mental health problems. After around 20-30mins of questions, the trainee asked me to wait outside again while they spoke to the Psychiatrist.

After another 5 mins, I was invited back in, this time with the trainee and the psychiatrist. I was told that I had a mild form of Borderline Personality Disorder, and was asked what my main issues were. I said I struggled with moodswings in particular. The doctor and I disagreed about anger, the doctor said they felt that was a problem with me and I didn’t agree, I still don’t, but I am willing to accept what appears. In total, I spent about 10minutes with the psychiatrist – in a psychiatric appointment. BPD was not explained to me. They said they didn’t offer medication, and that as I was due to return to Edinburgh in around a months time, they would not be referring me to services, but that when I got to Edinburgh I should ask my GP to refer me to Psychology and that he would write a letter to confirm this). I was then discharged. This was August 2013.

When I returned to Edinburgh, I asked for the referral, which again was handled brilliantly by an amazing GP. I received a letter a few weeks later saying that it would be a number of months before I would be seen. I have only just begun the assessment process with the psychology department in Edinburgh, making it a total of over 7 months to be seen. I am suicidal, depressed, have insomnia, and am failing my final year of Uni.

My question is – why would the Psychiatrist not refer me to services in Edinburgh, rather than discharge me? I appreciate there would still have been a waiting list, but this would definitely not have been 7 months. If I had a physical health condition, I would have been referred to the correct department in a different city. Why was this different because of a mental health condition?

How can I go from being referred as an emergency case, to being diagnosed to being discharged in about 6 weeks? I gained a diagnosis of a personality disorder, and suddenly my need for services reduced?

Another question – why, in an appointment which was supposed to be with a Psychiatrist, did I only have contact with a psychiatrist for 10 minutes?

I do not think this is acceptable care.

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Responses

Response from Maimie Thompson, Head of Public Relations and Engagement, Chief Executive's Office, NHS Highland

picture of Maimie Thompson

Dear MH Patient

First I want to thank you very much indeed for such a thoughful response. It is really, really helpful to get this feed-back. I have shared it with a number of colleagues and this morning discussed it with Sarah Muir AHP Lead and Occupational Therapy Lead for Mental Health Highland. Sarah tells me that there is so much in your response that is chiming with what some other people have also fed-back to us. It must just be so exhausting and disheartening when you are not being listened to and decisions being made for you not with you. A diagnosis is surely only useful if it is useful to you and to have it changed in the manner you describe, is clearly going to be upsetting.

Sarah tells me that work is definitely underway around looking at post-diagnoistic support and she really feels that we can learn an awful lot from your experience.

Through all the difficulties its reassuring to hear that your GP has been there for you and been such a strong advocate.

Can I ask you to have a think about some next steps and whether you would like to get in touch with anyone from Personality Disorder Services to hear from you direct or offer any support and sign posting.

Please feel free to get in touch with me maimie.thompson@nhs.net

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