Complex and severe conditions can require more specialist treatment than can be offered by a GP. GP’s are at ‘primary care’ level but can refer to ‘secondary care’, which in mental health is at an Assessment and Treatment centre (ATC) rather than a hospital outpatient department. These centres house teams of psychiatrists, community mental health nurses, social workers, occupational therapists, psychologists and other support staff.
If it is an emergency, then a GP can make an urgent referral to secondary care.
A GP will refer if he/she feels that the issues are too complex and need more specialist input. The initial assessment for a new referral may be with a psychiatrist, psychologist, senior occupational therapist or senior mental health nurse. Carers are often asked to contribute information, but a lot depends on whether the person accepts your help.
Just as many of us when faced with a doctor, the ‘patient’ may present themselves as perfectly fine! If you feel they are not being totally honest it is important that you give your information – in confidence if necessary. If you are not offered this option, then ask for it!
The cared-for person may be prescribed medication and/or a referral to a different practitioner, such as a psychologist, occupational therapist or a mental health nurse.
“It is very confusing when first coming into contact with the services to understand what service your relative has been referred to and why.”
Those with more complex needs will, after a period of assessment, eventually have a care programme approach (CPA) plan. This document details their treatment, frequency of appointments and emergency contacts.
As a Carer you should have an opportunity to contribute to this, but again this can be difficult if the person doesn’t want you involved. Requesting an appointment or phone conversation for yourself is an option if you have concerns about the plan.
Making a relationship with the professionals
“Many Carers feel helpless and abandoned, being pushed from pillar to post without any one able to help and the situation deteriorating. I think this is made worse because Carers, perhaps because of being under stress, do not understand the system and often professionals do not take this into consideration. It all seems such a fight and Carers can feel so isolated and helpless in seemingly unsolvable situations.”
Many Carers report that initially they feel rather excluded and overlooked by professionals and it takes time to develop a working relationship. Professionals have to prioritise their relationship with the unwell person to establish a sound basis for treatment. They need accurate information and you may feel you have that, but they do not yet know you or how you are involved. So appearing calm and quietly assertive may help your case more than losing your temper (because you are frustrated and desperate for help). That is always valid advice whatever stage you may be at – but it’s easy to say and hard to do!
If you find yourself becoming upset or agitated towards the professionals, you will not be alone. You are emotionally involved and they are not, tensions will arise. As time passes it is important that you can respect each other’s viewpoint and try to make a good working relationship. This will be easier both for you and the person you care for.
“I sometimes wonder, when waiting with xxxxxx to go into a meeting, how the doctors would feel if they had to wait for an interview that would decide their fate, month after month, year after year. They don’t let patients get angry, or family, you are either put down as ill or over-emotional. Considering the build-up of pressure before one’s monthly trial, I feel that both of these reactions are normal.”
“I turned to the out-patient’s mental health team and all they would say was ‘He can come and see us’. He wouldn’t even go out of his flat! Or they said ‘We went to see him and he wouldn’t let us in’. That let them off the hook. I felt really isolated.”
Family and partners have found themselves labelled as difficult, demanding, hysterical and irrational and as a source of pressure on the patient. Your natural reaction to extreme worry and a desperate need for the problem to be solved can make communication tense and frustrating.
Staff still vary in their willingness to give time to support Carers but often better understanding develops over time and good working relationships are formed eventually. There is far more sensitivity to these issues nowadays and a recognition that involving Carers is a good investment of time for MH teams.
Despite the need for a good working relationship there is no reason not to pursue issues, being calmly assertive and asking ‘why, when, and how’ questions.
“Never accept no for an answer, no matter how unpopular you become! Look at what you want from the situation and work towards those goals”.