What does a Community Mental Health Team (CMHT) actually do? Of course I do know what the remit of their existence is: Meeting the needs of people with mental health problems who don't need a psychiatrist.
But what if your GP decides you do need the input of a psychiatrist, why isn't her/his decision acknowledged, respected and action taken, rather than the CMHT swoop down on you instead?
We have a sixty year old resident ('Winnie') with complex mental health problems including ongoing addiction. You might think we are being remiss in not addressing her addiction but our hands are tied by Safeguarding Vulnerable Adults (SVA) and Deprivation Of Liberty Safeguards (DOLS) legislation, and of course, importantly, whether this legislation exists or not, Winnie has the right to choose her own path in life.
Winnie presents as quite a strong character with a seemingly happy disposition, but there are strong suggestions (of late) that all is not well. I love my job and see my main purpose as that of promoting well-being and being 'there' for the residents. I have regular daily chats with many residents and these chats, quite rightly represent the bulk of my work.
Winnie is one of these residents. We chat about everything past, present and future. As said, of late, there are obvious signs that all is not well and our chats have taken on a deeper nature. She talks of a deep depression that she hides under her happy veneer and indeed, my last post is based loosely on that she has disclosed - the real Winnie.
Her depressions is something that she has coped with for the majority of her adult life. She receives antidepressant medication and it has been enough - along with her own self-medication of alcohol - to control her symptoms until a recent event led to feelings of helplessness and hopelessness that dogged her in her early twenties.
We contacted her GP who is a good GP who visited Winnie in the home and spent time with her, listened to her, increased and augmented her antidepressants and referred her to psychiatric services.
Psychiatric services initiated a CMHT visit, although which professionals were represented in this team we do not know as we were not privy to this information. Why might this be - perhaps the bad reputation of care homes and the assumption we would not be interested? If this is the case - it is bad practice.
The team spent half an hour with Winnie and left - no staff being approached to give input into Winnie's situation. A few days later, my manager was contacted by a psychologist (who had not been part of the team) to advise that the home was to be reported re SVA and DOLS issues in relation to Winnie. Flabbergasted my manager asked why and the reason given was incredible. He asked why he had not been contacted previously as to enable the team to be aware of the true facts and was met with an embarrassed silence. We were not reported, nor did we receive a cc of the letter to the GP which is good practice and good manners as we are very much involved in Winnie's care.
Winnie continued to deteriorate both mentally and physically and my manager contacted the CMHT again requesting further input, only to be told that their work was done.
What is their purpose?
The good GP is bringing together a CMHT of her own making and being a good GP visits Winnie weekly as she shares our concerns. In the meantime Winnie continues to suffer. Hopefully, somewhere in the near future, Winnie will receive the input of a good psychiatrist, emphasis on good as we have four psychiatrists who serve the residents in our home.
One is a good psychiatrist - the old school variety of 'doctor knows best' who listens to and understands the real needs of his patients and follows up their care regularly. His patients have the best outcomes.
The remainder are of the newer breed who offer choice-ism. "Which tablets do you want to take?" and/or "I hear you attempted to strangle X - can we discuss this?" (if "No" to the latter it is not addressed!) and is all well and good until you display florid psychosis and/or come very near to actually strangling X and are sectioned. What kind of care is this?
You are never offered the choice of mental ill-health - but hey, even if you lack insight you can choose your medication based on the knowledge you acquired while being a medical student! You were not a medical student? You don't have a degree in psychiatry? Never mind, your mental health issues may not be addressed - but hey, you do have choice!
You may think from the above that I believe those with mental health problems have no rights at all - but this is not the case as I am very BIG on the rights of residents, as is my home. I believe they have a right to the best of treatment and not the superficial fluff of caring they receive now, although as said, even receiving superficial fluff takes an awful lot of time to get to as there is an awful lot of hoops to jump through first. And you continue to deteriorate.
What say you?