NHS GPS and Psychiatry

[Olderal]

I recently received a very helpful PM which coincided with my views that while the standard of GPs in Britain is generally high as a result of well defined and good training, the standard of NHS Psychiatrists varies far more. General Practice is of course easier , there are temperatures to take and spots and other physical symptoms to observe.

I feel Psychiatry is less well understood as a result of which opinions vary within the profession leading perhaps to less well defined training ,differences in interpretation of symptoms again leading to less well defined training and a generally lower standard within this part of the NHS. No spots to look at either. Mental health services have tended to be the poor relations as regards funding which does n't help either.

I would be interested to hear from others as to their experiences with GPs and Psychiatrists. Maybe we should have a poll on this issue ? Who knows it might even lead to additional pressure to increase funding for mental health services and training.

[Hidden]

Olderal

You need to understand how bad rationing is in the Mental Health field at this time and the number of people who need help.

Actual referrals to Psychiatrists, is not that common on most occasions you may be seen once then referred to a CPN then possibly to various other specialists. They generally prefer a patient to have a course of CBT and move on with a list of coping techniques.

Many treatment plans are undertaken in hospital by Specialist Nurses, that releases the higher up to deal around various ward environments.

When patients are discharged from treatment many are advised to attend Mental Health Day Centres, they do have interests in taking up the slack, Patients then get support from their Peers and that allows them to mix with each other and help them to move on

[Fi68 in reply to Hidden]

However it is only a psychiatrist that can diagnose severe mental disorders and prescribe for them. All the other services you mention are under the management of the psychiatrist. I have a severe mental disorder and I have never been admitted to hospital. Does my GP think there have been occasions when I should have been - yes, does my husband - yes, because I was clearly a danger to myself. However I am a white, middle aged woman, with no children that could be at risk from me, and so I never get admitted. The only person at danger from me, is me. There are no beds at the regional unit, so people are always been sent out of area, and I am sad to say that most of the beds that are occupied are by drug users who have either taken something and had a bad reaction to it, triggering a psychotic episode, or they are detoxing and need constant monitoring. Therefore psychiatric wards are very busy, fairly chaotic, noisy, threatening and often violent places. Not ideal if you need a quiet, safe space.

There are no local mental health day centres locally to me. There are various projects that are run by charities, out of church halls etc, however in my experience, the activities offered are simplistic and quite patronising. When I visited my local Bipolar support group, they had a woman speaker who was into crystal healing, who proceeded to clean our chakras, by wafting her hands about and shaking a crystal over our heads whilst muttering.This was supposed to clear our minds of the bipolar. I have to say the whole experience was an exercise in bladder control as I was trying not to laugh so much I nearly piddled my pants. Needless to say I never returned.

Fi.

[Hidden in reply to Fi68]

Fi

I do agree what you say however a first appointment scenario depends on the patient and the seriousness of the condition. In my case I was last initially seen by a Crisis Team and then the trick cyclist, after that I was given my CPN and a Psycologist (excuse spelling) for various tests at home, because it was dementia the trick cyclist came back to see me to explain a diagnosis. I was then moved on to my CPN.

What I am saying, all depends on what is wrong with the Patient.

Over the years I was on Healthwatch and would discuss and sometimes attend Mental Health Wards and I can understand many patients will feel at some type of risk on Ward. In my area Wards have different types of Patient not all used by violent Patients or drug users.

Day Centres vary in mine members were given courses of CBT on top of what they were given by their GP, we also had an Information Centre and that was used by people coming in from the street and the Centre. Night outs were arranged as was day trips in Summer. The whole ethos was to give support and members been there for each other. I was in the Information centre for about ten years.

Patient pathways are all different, it depends on the Patient and their Needs.

[Fi68]

Hello borderriever, I think your answer raises an interesting point about the difference between organic brain disease and mental disorder. There was a guy called Thomas Szazs who wrote The Myth of Mental Illness, he was a psychiatrist in the USA. His premise was that unless you had an organic brain disease you did not have a mental illness. Organic brain disease should be treated by neurologists etc. He said that mental illnesses were actually people having problems with living, and that psychiatrists should not have the ability to detain and force treatment or the ability to prescribe medication. He stated that he did not think that psychiatry was a valid medical discipline because there were no standard scientific tests that could be run to prove mental illness. Now his view is certainly from a very Conservative American perspective, but it has found some following as it is seen as anti-psychiatry, even though Szazs himself abhorred this term and was horrified to be lumped in with the likes of RD Laing. It is an interesting philosophical perspective and certainly contributes to the current debate in western psychiatry.

Fi.