Dr John Crippen
for many of us its much worse than this because our GP is not the island of sense in a sea of shit portrayed here, he is just another lump of shit in the same sea
really massively underplays how crap the system is
Interesting stuff, this.
I have a daughter age 18 who has been unable to start university due to acute severe depression. When she was really bad it was a case of hiding the tablets and worrying ourselves sick. Now she is merely housebound, although very slowly getting better.
Our GP has been brilliant, but as you so nicely (pun?) point out, what she can actually do these days is very limited. My daughter was assessed by a CPN, a nice lady with her heart in the right place, but at no time was a full history taken. My wife, also a medic, has spent quite a lot of time telling the CPN things about the family which we felt were relevant. Daughter was seen by a psychiatrist after 3 weeks, another nice lady, SPR2 but seems to be on the ball, thank heavens. I have spoken to the consultant who is in overall charge, but he seems to have very little idea of my daughter's condition. He has not seen her himself.Professional courtesy obviously dead, here, but there you go I am not after special treatment, just the best for my daughter. As anyone would be.
I've had a look at the latest guidelines on depression published by the RCPCH. These go along the lines of NICE, but ONLY ONE point is supported by class A evidence. The RCPCH are at pains to point out that they were not responsible for the original guideline.
What's my point? Psychiatric services are overstretched. We are not doing too badly by most standards, but it should not be a matter of luck. Our GP has spoken to the nice SPR, but it took a long time for a person in trouble to be seen. The bulk of GP visits for mental illness are related to depression, AFAIK
And mental illness is hell for everybody. I wish it was as fashionable as breast cancer, then we might get some action.
I think that the tier 4 service I had a clinical placement at was very well resourced (for the NHS). However, we did have issues with:
i. Trusts not wishing to fund several children's stay.
ii. Contact with the home area - curiously, a lot of GPs did not seem to view themselves as having a role when the child returned home (even in conjunction with the local psychiatrist).
Hi OT student
Can you talk me through the role of the OT in Tier 4?
Thanks
John
the system sucks. period.
Make up your mind, old fruit: "professional courtesy" is just a euphemism for special treatment, why deny it? If you want "the best" then it's special treatment you are after, without paying for it.
Just discovered this blog. Nice to know there is more than one of us in cyberspace.
How many times was the word nurse used?
Surely mental health nursing is important in managing children with depression and other mental health problems?
Interesting issue though. The GP the BBC breakfast news uses was on this am, she wasn't sure obviously if this child is depressed or not, but spoke of parents transferring their anxiety over school places to their children and the number of parents who write to her to support their appeals. She said that while some of the children have medical reasons to be admitted to a specific school many do not and the parents are trying to medicalise the problem.
Make up your mind, old fruit: "professional courtesy" is just a euphemism for special treatment, why deny it? If you want "the best" then it's special treatment you are after, without paying for it.
dearieme |
+++++
We don't get many perks in our business, and "special" "fast-tracked" treatment used to be one of them. This is true less and less. Doctors have an awful time as patients; remember that for every five things that you can imagine going wrong, we can think of fifty.
Interestingly, a huge part of the Hippocratic Oath (which no one in theUK takes, or has ever taken) is about looking after colleagues.
John
How many times was the word nurse used?
Surely mental health nursing is important in managing children with depression and other mental health problems?
Interesting issue though. The GP the BBC breakfast news uses was on this am, she wasn't sure obviously if this child is depressed or not, but spoke of parents transferring their anxiety over school places to their children and the number of parents who write to her to support their appeals. She said that while some of the children have medical reasons to be admitted to a specific school many do not and the parents are trying to medicalise the problem.
Julie
+++++
Julie, "nurse" was used a mere 9 times; once more than doctor, three times less than psychiatrist.
Do remember that nurses are highly trained professionals, with a definite skill set and thus are expensive. Far more expensive than "primary mental health workers"
John
A 4yr old child becomes 'depressed' because she is seperated from her pals ?
The solution is to call in a psychiatrist ?
Surely this is a prime example of medicalising problems in living ?
Some schools of family therapy recognise the dangers of therapeutic impasse when 'pathology' is sited in a child [the symptom bearer] rather than the network or 'system' [meaning friends, family, social structure] surrounding the child.
Referral to family therapy services might arise when a child develops 'symptoms'.
These so-called symptoms might then be reframed as difficulties in adapting to a new foster home, or the consequences of a particularly unpleasant divorce, or when a parent [for whatever reason] simply does not have the resources to meet the childs needs.
It might even arise when a child fears loss of contact with school mates [or if he/she is attenuated to disproportionate levels of parental anxiety about it].
Maybe some 4 years olds do develop an organic brain syndrome resulting in 'depression', but it is a controversial topic and I doubt if there are too many John Bowlbys out there.
I'm afraid this one area where even the experts advocate different schools of thought.
Without wishing to sound like a creeping fan, as someone with intermittent experience of the mental health system in the UK over the last 19 years (from age 7, so I remember a few things about the decline of child psychiatry, and also now have a reasonable understanding of the shambles my local mental health services are in), I cannot help but think that if every patient with mental health problems had a GP with the insight and awareness of Dr Crippen to advocate for them, then their lot would most likely be far better than it is now.
I know Dr Crippen doesn't really criticise other GP's (and fair enough, why should he - it isn't attractive or very professional for colleagues to bitch about each other in public, there are appropriate channels for that sort of stuff when it's on your own team i guess), but I also know I'm not the only one to have the poor fortune to have a GP, who, quite frankly, is clueless at best.
I've seen more useless nurse/OT/I really don't know what quacktitioners than i care to remember, but given the choice of trying to trust them or my current GP in an emergency, it's a struggle to believe that the extra training and skill my GP has supposedly acquired at some point would actually help at all. It's not even the inability of some GP's to grasp either the art or the science of medicine, or even the application of insight. A minority of GP'S in this country just seem to have this ability to just as bad as many of the nurse practitioners.
My mother, and some of my best friends are GP's, and one fantastic GP saved my life two years ago, so i really don't dislike them all, but even they are constantly horrified; almost GMC-letter-time-horrified at the latest mistakes from my current GP.
I know GP's are being backed into a series of ridiculous scenarios and restrained by bizarre and poorly thought out protocols, but surely they cannot say that as a group they are perfect, and blameless in the failings and neglect of patient care that's currently playing out in the NHS?
" Hi OT student
Can you talk me through the role of the OT in Tier 4?"
Probably not in the same sense as someone who actually works in that sphere, but I can certainly tell you what my role involved during my time there (inpatient unit specialising in eating disorders).
I was primarily involved with those over the age of 16. Activity analysis was central to my practice, and the unit had a strong emphasis on CBT (which I happily used in group sessions, for example to build stress management techniques to increase resilience), but often switched back to humanistic or solution-focused approaches in individual work as a lot of the young people were very disenamoured with CBT, and it wasn't always the most appropriate approach.
For some of the young people, their focus was on transition to adult services, return to education, finding somewhere to live when they left the unit etc. Self-management was also of prime importance to the older ones (as many of the young people had chronic mental health conditions, and there is a big difference between adult services and CAMHS - adult services are feared by many of the more seasoned young people needing services).
For others, (particularly those on (for example) heavy doses of anti-psychotics), there was more of a focus on basic self-care and basic activities of daily living, together with activities individual to the young person that would encourage them (e.g.) out of bed to start with.
I would also say that OTs have a strong role within the MDT. After the nursing staff, we spent the most time with the young people, and thus could observe any behaviour/possible drug side effects, which then informed treatment. We also had to deal with sudden disclosure for the same reason.
For example, if a young person's only moments of lucidity occured during OT, that might affect the psychiatrist's decision on appropriate medication changes, as opposed to if the psychiatrist had heard that the young person was having constant psychosis.
We also did work around social networks, creative therapies, family work, social skills and time management (balance of education, work and leisure, as well as working on an appropriate balance of leisure activities...which does not mean the gym 14 times a week, netball 3 times a week, and a 5 mile run each morning).
I am still trying to work out why the staff grade doctors and student nurses were only expected to listen in clinical rounds, but I was expected to feedback on the entire week of intervention for each young person.
I know that teams are not always appreciated, but this was one of the best teams I've been in in terms of appropriate communication and teamwork.
I also felt that most of the unit accepted me as a person first, rather than a freak in a power chair (or one of the patients/clients - despite being 10 years older than them, I was mistaken for one once). However, that's a lot less times than people have mistaken me for a patient when I've been in uniform in a more acute setting. It probably helped that the staff were accustomed to movement disorders as side-effects, and that I was working with young people rather than adults. Young people appear to be much more accepting for some reason.
I'm sure that one of my qualified colleagues could explain all of this better (I'm suffering lack of sleep secondary to an upcoming viva, dissertation work and clinical placement).
Interesting, Child Psychiatrists are in such sort supply around these parts that one is (or was) flown in from the Far East for six months at a time to chop down the waiting lists, so I guess we have 1.5 for the entire county.
Putting the current story aside, that's not an acceptable level of service is it?
SD 
Dr Crippen, I do wish you would stop using the sarky "" around the words health care professionals. I am a professional and I work in health (and social) care. That makes me a health care professional. You clearly don't approve of some of the changes in health care, but that doesn't mean the staff are not professionals.
OT student - do you use the COT website discussion boards at all?
Hi Rose
GPs don't have a monopoly of perfection; there are plenty of bad onese around, just as there are bad architects, and bad newsagents.
I am no paragon of virtue, believe me! Obviously, this is my blog, so however objective I am, I am sure I err on the side of painting myself in a good light - I am human, and I have insight. But I hope that you don't think I am using this a way of saying how wonderful I am. I am not. I am set in my ways, intolerant and I do not suffer fools gladly. And as my definition of a fool is someone who does not agree with me, that causes problems from time to time.
Believe me!
John
"OT student - do you use the COT website discussion boards at all?
Kirsten | 09.11.06 - 9:53 pm "
Yes, and I'm fairly sure that you could take a wild stab at who I am.
Dr John, you are not the problem
the problem is some of your fellow GP's who really are useless
and the medical profession clearly knows some are not up to scratch, and there is nothing in place to systematically sort it out
for some of the more obvious stuff the patients cannot even take their business elsewhere, as we are all subject to crazy distance rules now
rice production is up this year
Dr Crippen, I do wish you would stop using the sarky "" around the words health care professionals. I am a professional and I work in health (and social) care. That makes me a health care professional. You clearly don't approve of some of the changes in health care, but that doesn't mean the staff are not professionals.
OT student - do you use the COT website discussion boards at all?
Kirsten |
+++++
You see? I told you I was no paragon of virtue! And intolerant.
My use of inverted commmas in this context if very specific. I use them to convey that fact that in the dumbed down, cost saving new Labour NHS the "health care professionals" are being used as a cheap alternative to doctors.
I have no "down" on OTs - and never put OT in inverted commas! Of course you are independant professionals. So are architects. If they started using architiects to do hip replacements, I would put architect in inverted commas too.
JOhn
There's as many OTs on here as there are on the COT discussion forum. the same few people turn up everywhere!
Just to point out Dr Crippen: I can't speak for CAMHs, having never had any placement there, but generally these documents from NICE state the obvious to everyone.
It's just those in charge (and some doctors it appears) who think everyone except them needs talking through each task, step-by-step.
One other issue: you say 'most members of the CAMHs have no medical training' who exactly are you talking about, and what do you define as 'medical training'? Normally you talk a lot of sense, but you do seem to get a bit hung up on some issues. You don't need to be a qualified doctor to be able to take a history! As far as I'm aware most professionals learn to do the things like this while studying their particular discipline, it just has different names within each profession. I certainly learned how to do these things as an OT student, that was the point of placement: learn the job!
HI Juli
I am venting my frustration that I am not allowed to refer my patients to child psychiatrists any more. I can only refer to CAMHS.
By medically qualified, or medically traineed I mean DOCTOR. You know, five years at medical school followed by some searching exams, and then 1 (now 2) years as a houseperson.
John
not sure that this kid is depressed. I think that's a smokescreen for the real agenda.
The parents want to send the kid to the local school, rated "Very Good" by Ofsted.
Instead she's going to go to a school which is
"situated in a disadvantaged area of Sunderland where there are high levels of unemployment and most of the housing is owned by the local
authority."
and only rated satisfactory.
Her pushy parents have got her to pout for the photo and gone to the doctor to make a fuss so she can get her place in the school of the parents' choice (the better one), and avoid a longer journey to school. It is eminently sensible. I doubt the child even knows she is supposed to be depressed, but the doctor is playing along, recommending she be "reunited with her friends".
If you do not earn enough to send your child to private school you have no other choice.
This is Blair's Britain.
John
It's ok, don't worry, i'm not seeing anyone as having any particular claim on virtue on this one. I don't think anyone's perfect, and especially don't regard blogs as a suitable tool to assess someone's virtue or otherwise anyway. Bias and personality is quite a big part of what you expect with blogging isn't it?
I guess what i was trying to say (In my usual slightly less than concise way) is that it's not really about virtue or well meaning. Some GP's are just awful at what they do. [Just as some OT's are probably fab...OT...you have adult eating disorder services in your area?? There are virtually none in my city]
Maybe it's that my GP went into the wrong profession, or that medicine has changed so much since they qualified that they are no longer able to cope with the demands put upon them (is anyone?). I think the point i wanted to make though is that GP's say things (and this includes a number of peole i know, not just Dr Crippen) that actually suggest that they care about their patients, want to help them, and spend time and energy trying to understand their patients needs and listening to them. It makes me sad that when i see that now i want to congratulate that doctor for their insight and extraordinary standards. - I'm young and idealistic (and a vet not a medic so not as jaded as my medic-friend peers yet!) and think that all doctors should be like that, and that it shouldn't be an extraordinary standard at all, but absolutely the norm.
I guess i'll learn one day...
Cheers
Rose
Ah, but Rose,
Vets are clever than doctors.
Tell me, is your profession dumbing down? Are you getting "animal care practitioners"
Serious question!
John
'Make up your mind, old fruit: "professional courtesy" is just a euphemism for special treatment, why deny it?'
so I quote from my original post:
'Professional courtesy obviously dead, here, but there you go I am not after special treatment, just the best for my daughter'
Can you read? Is there a denial?
Let me tell you how I work. Any doctor, nurse or other health employee who needs care from me gets it personally. I do not delegate this to trainees.
I am old enough to have actually taken the Hippocratic oath. Again, I quote:
'To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him'
I freely admit I am terribly old fashioned. But I do sleep well.
I don't want to sound cynical but a 4 year old child diagnosed with depression?
Having worked with "looked after children" who have been found in wheelie bins because it was minus 2 outside and their parents were still in the pub, children taken into care because their mother tried to sell their little arse for crack, children battered to within an inch of their lives, and a child who ....well i could go on but some of the stories don't bear repeating and you really don't want to know. In my experience many of these children had/have mental health issues but try telling them they need pyschiatric help and they blame themselves further.
The stigma of being in a childrens home when no-one else at school is and all the feelings of being rejected and unloved by those they value most already makes their self esteem at an all time low. Unfortunately their mental health is down to those 'well meaning' individuals who may or may not have the oxbridge training but who have successfully supported young people through a period in their life and provided stability, understanding, patience, and time. That's front line work for you.
Sorry not related to this post but I couldn't find an email address to contact you (I'm not having a very clever week, with a surgeon telling me I should be studying to be a GP at a PBL based medical school on Tuesday which is the ultimate insult a surgeon can muster...)
Have you seen
http://www.timesonline.co.uk/
art...2446250,00.html
?
I'm so pleased that the times has managed to highlight that medical training hopefully helps you get it right in more than 58% of cases....
"Just to point out Dr Crippen: I can't speak for CAMHs, having never had any placement there, but generally these documents from NICE state the obvious to everyone."
Can't argue with that...which I presume is why we are supposed to be able to critically evaluate NICE guidelines by level 2 (as opposed to copy what they say).
Rose, if you were talking to me when you mentioned adult eating disorders (unlike Kirsten and Juli, I'm not an OT...just a student), the answer is no. I was talking about tier 4 in Child and Adolescent Mental Health Services. I happen to live an hour from a regional unit that has agreements with trusts from two SHAs (of the new variety).
I can't speak for CAMHs, having never had any placement there, but generally these documents from NICE state the obvious to everyone."
++++
Yes, I am sure you are right. This new Labour. They equate laying down a protocol with solving a problem. It does n't solve anything and, as you say, so much of NICE's output is egg sucking for grandma's.
But it all has a specious credibility that Patricia and her focus groups like.
John
Bearing in mind that, as 2nd years, we were expected to be able to critically evaluate the NICE guidelines for a given case study (i.e. point out where the given protocol is inappropriate), I'd be tempted to agree with Juli.
'Unfortunately their mental health is down to those 'well meaning' individuals who may or may not have the oxbridge training but who have successfully supported young people through a period in their life and provided stability, understanding, patience, and time.'
Without the dedication of poeple like this the mental health service would fall apart completely, no argumant. But that's the point. It should not be so. The biggest cause of morbidity in the UK should be funded properly, not left to charities etc. to pick up.
Thanks Crippo but i am not in the mental health service. My point is that young people in a care environment can have mental health issues but are reluctant to have any involvement with mental health services.
I agree that many illnesses go undiagnosed and that there should be more funding but that funding should not always be in support of the hierarchical system advocated above. The wages of one psychiatrist if spent directly on some of these 'looked after children' could make such a difference.
John, I agree with most of what you are saying but do feel that 'medicalising' all problems is not a solution. Being able to take a comprehensive history,interact with the child, talk with family and offer appropriate interventions (including referrals to medics if necessary) is frequently done in such teams, usually by psychologists, or do they not count?
Dear Dr Crippen,
It's not surprising that there is a shortage of Psychiatrists (whether child or adult) since they are only too keen to take on illnesses that they are not qualified to - ME/CFS being one case in point.
NICE are currently "consulting" on the draft CFS/ME Guidelines. They have widened the diagnosis to all those who have "chronic fatigue" rather than "chronic fatigue syndrome" and are going to advise CBT and GE (graded exercise) to all.
Draft guidelines here (this is the Short version, which is a mere 48 pages long!):
http://www.nice.org.uk/
download....e=download.aspx
Of course most ME/CFS patients don't actually get to see a consultant - they see a nurse specialist or a physio or an OT at the so called specialist centres for CFS/ME.
The NHS has already issued guidelines anyway so have pre-emped NICE.
Occupational Aspects of the Management of Chronic Fatigue Syndrome: a National Guideline (64 pages)
http://www.dh.gov.uk/assetRoot/0...37/
04139437.pdf
Occupational aspects of the management of chronic fatigue syndrome: evidence-based guidance for employers (8 pages)
http://www.dh.gov.uk/assetRoot/0...32/
04139432.pdf
Occupational aspects of the management of chronic fatigue syndrome: evidence-based guidance for healthcare professionals (12 pages)
http://www.dh.gov.uk/assetRoot/0...35/
04139435.pdf
Occupational aspects of the management of chronic fatigue syndrome: evidence-based guidance for employees (8 pages)
http://www.dh.gov.uk/assetRoot/0...34/
04139434.pdf
As a PWME (person with ME) myself, I despair!
Thanks for your blog!
Sorry, dyslexic fingers, that should read The NHS... have pre-empted NICE.
John, I agree with most of what you are saying but do feel that 'medicalising' all problems is not a solution. Being able to take a comprehensive history,interact with the child, talk with family and offer appropriate interventions (including referrals to medics if necessary) is frequently done in such teams, usually by psychologists, or do they not count?
Poppy
++++
Agree with you 100%
What I am railing against, is being prevented as a doctor from referring my patient to another doctor (a child psychiatrist in this case). It is not acceptable that when I want to have such an opinon the child may well still only be seen by a "mental health worker." Whatever that is. No one really seems to know.
John
I'm not sure about four-year-olds developing depression solely over choice of school. But this post rang so many bells for me and is a representation of exactly how things work in children's mental health services.
As a teenager, I was referred to the area's child psychiatric services. It was a very concrete thing (rape and abuse) that happened - so my mental health problems were not a matter of my mum's/GP's/teacher's/milkman's opinion, no one was really going to argue with me needing some help.
Nevertheless.
Referral from GP to MH services. Waiting list *twiddles thumbs*. Informed by GP about local free counselling (staffed by volunteers) in the meantime. At the second session the counsellor tells me that she does not feel qualified to deal with the magnitude of my problems, and writes a letter to this effect to the MH services to be put on my file.
Still on the waiting list *twiddles thumbs*
Saw a Community Psychiatric Nurse. Mum and I spent several hours giving her all the history etc etc blah blah. She agrees that I need help (no, really?) and refers me to a behavioural psychologist and a psychiatrist.
On a new waiting list *twiddles thumbs*
Saw the behavioural psychologist. Did half a dozen sessions of CBT and, at last, my mum was given some information about how to help me in her capacity as my primary carer. Better late than never.
Still waiting for the psychiatrist *twiddles thumbs*
Psychologist is "downsized", last one in so first one out. Bye. No one else can take me on where she left off.
Finally see psychiatrist who decides that she is not qualified to deal with problems like mine and refers me to another psychiatrist.
Waiting list for new psychiatrist *twiddles thumbs* (you don't want to know how much school I missed while twiddling my thumbs)
New psychiatrist offers counselling from a professional counsellor on the NHS. Unfortunately the child counsellor she wants me to use is based not 100 yards from where the rape occurred and my attacker lives. I decline the offer on those grounds. Apparently there is no alternative, unless I wish to start over with the free counselling service mentioned above.
Eventually at the age of 17 I was let into the Adult services and immediately allocated to the consultant psychiatrist, and a MH daycare centre. Although far from perfect, things improved from then in.
*caution – obsecenely long comment, please ignore unless a ramble on the state of vet medicine vs the ‘dumbing down’ of human medicine is of interest.*
John
Please don't get me started on the whole 'vets are cleverer than doctors thing'. I've yet to meet a vet whose professional arrogance and narcissism extends that far. Maybe we are just too intelligent(!), but more realistically i think that even though it can be fun to watch medics get a bit riled in a social context when a student at some interfaculty sports event by donning one of the US-vet-school propaganda t-shirts with the slogan 'Real doctors treat more than one species', or the slightly more UK-style comparison between the definition of doctor and vet (UK vets don't call themselves doctors as vets do in much of the rest of the world because we are veterinary SURGEONS you see); Doctor in this ‘humourous’ context being described as (to doctor) 'To impart a false character to (something) by alteration, or to make impure or inferior by deceptively adding foreign substances', (or similar, you get the idea I'm sure), whilst using the definition of Vet (to vet) - 'To subject to thorough examination or evaluation'). Such irreverent comparisons can be of some comfort in the initial stages of despair after another run in with my apparently very flawed GP, but more seriously, I’ve never met a vet who actually buys that stuff. As a profession I think we can learn a lot from you medics (both good and bad), and comparative medicine can be fantastically interesting and useful.
In response to your question, my personal opinion, having spent the last 13 years devoting almost every spare moment of my time to veterinary medicine – it becoming a full time concern for me seven years ago; and also having spent much of my life hearing daily accounts from my mother (who is an FRCGP and senior partner in a large urban GP practice), and more recently, from a number of close friends traversing the perilous journey into general practice, I would say that absolutely no, the veterinary profession is not experiencing the dumbing down that is so undermining the practice of some areas of human medicine in the NHS.
As a profession vets do have immense challenges at the moment, everything from the new strategy for formal postgraduate training which is being put in place from 2010, to the debate over the lack of support and immense pressure some newly qualified vets face, to the fears over the effect of the competition commission’s review and the subsequent ruling that means that pharmacists can dispense veterinary medicines, (there were concerns over this; that pharmacists receive training in human pharmacology, but would not be aware of the many species differences that apply in veterinary pharmacology, but so far, the disaster that it was hailed as, seems to be failing to materialise, and hopefully in the long run our clients will get a fairer deal), to the concern over the way our profession is responding to the changes in the agricultural industry and the provision of 24 hour veterinary services to remote areas, and many, many others…I could devote a blog to it if I wasn’t so tired outside work at the moment!
We do have technicians increasingly doing some traditionally vet-only jobs, such as equine dentistry, and aspects of remedial farriery, and physiotherapy... but the regulation of such practices is strict, and seems if anything, to be becoming stricter rather than the trend seen in human medicine. Veterinary nursing is also changing, and the highest qualified nurses are allowed to do some aspects of what some people might consider veterinary work – very minor dentistry, not including extractions, anaesthesia under supervision of the vet etc etc, but nothing like on the scale that seems to be happening in human medicine. Almost without exception the vet nurses I’ve worked with have been highly motivated, highly skilled, fantastic veterinary nurses. Those who want to become vets generally do exactly that, the others nurse. Vet nursing is a very challenging and skilled job, but it’s still distinct from practicing veterinary medicine and surgery. There are laws protecting animals so only veterinary surgeons can peform acts of veterinary surgery on an animal, and these are strictly enforced – as i understand it vets can be struck off for allowing nurses to perform ‘supervised procedures’ not under their direct supervision.
I suppose part of the reason for the advantage we vets have over doctors in this respect is the way the veterinary 'market' in the UK operates. If for example I want to refer a dog to a specialist oncologist, I can do exactly that, the dog may be assessed by the oncologists trailing vet students, and intern, and resident, (such specialists are still often based at university teaching hospitals) and they may be the ones who interact with the client in the first instance (client=human, patient=non-human animal!), but the consultant will have control over what happens to the patient if that is what I request. Clients (or increasingly their insurance) pay directly for the service we provide. Competition is increasingly fierce, if they are not satisfied with the standard of care they are offered, they can walk out and go to another practice nearby. It’s true that increasingly the trend seems to be for large, often multinational firms to buy out small vet practices and then subcontact the work back to the local vets, and I could debate that for ages (don’t worry I’ll spare you), but again, increasingly that has the opposite effect of dumbing down. Our practice is increasingly regulated (such as the RCVS veterinary hospitals scheme), and the standard of veterinary practice is increasing in many ways.
Sorry for the rather ridiculous length of that. Something tells me I could have just answered ‘no’ and smiled knowingly, safe in the knowledge that I’m glad I didn’t apply for medicine instead of vet…
Cheers
Rose
Okay, a few points on CAMHS, since I've worked on one.
Primary Mental Health Workers. I've met a few, had some cosy chats about what it is that they do. Mostly it seems to be a liaison and advice role. As I understand it they're a point of contact for people working in primary care who come across a child mental health issue, but aren't sure what to do.
John, I feel I should reply to two of your comments regarding Primary Mental Health Workers.
It is only necessary because “primary mental health workers” have displaced psychiatrists.
This is simply untrue. Let's get this into perspective. There is ONE primary mental health worker to cover the entire city I live in. This is soon to expand to a whopping total of two. They haven't displaced a single psychiatrist, at least not where I live.
Do remember that nurses are highly trained professionals, with a definite skill set and thus are expensive. Far more expensive than "primary mental health workers"
Also untrue, since a primary MH worker is usually an experienced RMN or social worker.
I would suggest, John, that if you don't know what a primary mental health worker is, you might want to refrain from stating how much they cost. I would also suggest that if you don't understand a particular person's role, perhaps you might wish to find out, perhaps by phoning them and asking them, rather than simply going into a huff and assuming it's another New Labour gimmick.
Why was the Welsh Assembly there? Are all Welsh children mad? Or do they sing to the nurses, who were also invited?
What was the Welsh Assembly Government doing giving its input into child mental health policy?
Okay, I'll explaing that one. Stop me if I make this too complicated.
The Welsh Assembly Government, you know, that government thing that has an assembly, one that's Welsh.....well, it's the.....GOVERNMENT of WALES!!!! And the funny thing about stuff that involves POLICY.....and specifically POLICY that affects WALES.....is that it tends to require the attention of the GOVERNMENT....of WALES!!!!!!
If you have any further questions about how GOVERNMENT POLICY may attract the interest of the GOVERNMENT, feel free to ask.
But anyway, CAMHS teams. The one I worked one had various professionals working on it psychiatrists (from SHO to consultant), family therapists, clinical psychologists, one primary mental health worker (just the one!), support workers, oh yes, and nurse therapists.
Yes, yes, nurse therapists, more nurse quacktitioners. Except that the nurse therapist I worked alongside was highly respected by her colleagues, including doctors, and also by patients. Parents would come in and specifically ask for this nurse therapist by name, because other parents had been so impressed by the job she did of turning their kids around, and had told their friends how effective she is.
Overall, the CAMHS team I worked with didn't seem to have any problem with getting a child to see a psychiatrist if they felt it was needed. CBT seemed also to be much more readily available, and with a much shorter wait, than with adult services. Add to that a short waiting list and caseloads within manageable limits, I thought they were doing a pretty reasonable job.
Although my issues are a mile from Mary's, my experiences with CAMHS were pretty similar, in short.
See GP about depression, decline fluoxetine and opt for counselling.
After 6 months of waiting for said counselling, take the fluoxetine.
Fluoxetine does little more than make me irrationally suicidal (and there was me thinking the black box warnings were full of crap).
See locum GP, talk of suicide appears to wig her out somewhat so she takes me off the fluoxetine and gives me a referral to see a psychiatrist (or so she says). Funnily enough the appointment for counselling turned up at this point, only it was for a voluntary group who don't deal with people with "suicidal tendencies".
Wait a month, spend much of said month researching a combination of suicide methods and anti-depressants, set date to kill self.
Get an appointment with a nurse, sent to my mum completely against my wishes.
See the very nice, but ultimately useless nurse.
Wait 3 weeks.
See a psychologist who again, while nice, is somewhat useless.
Wait another month, seeing the psychologist once a week.
See a reasonably nice psychiatrist who prescribes me a different SSRI (citalopram) which makes things not so bad, but not really better in any describable way.
Continue seeing the nice, but somewhat useless psychologist.
Get told that I'm unlikely to qualify for the adult services and things will get handed back to my GP once I turn 18 and my CBT sessions have run out (2 weeks).
Try to stick out the month before my next appointment with the psychiatrist, where if I'm lucky, the SHO won't scoff at the idea of pharmacologically poking one or two different neurotransmitters with something other than venlafaxine.
somewhat related. Incapacity benefit claimants have gone up from 600,000 in 1981 to 2.7m now. The implication is that the extra people are essentially permanently unemployed, as there are presumably no more disabled people now than before. GPs have been blamed for signing them off.
Do you deal a lot of workshy people? Do you face any moral confusion in signing them off for a lifetime of disability benefits?
Thanks for the outburst, spiritof1976. It warmed the cockles of my Cardiff heart.
I've only just read this bit on your blog and can only agree that MH services are appalling especially where children are concerned. My daughter had moderate depression with anxiety. Had panic attacks since about age three, but I always hoped she would grow out of it so she never saw a doctor until she was 15. The first one tried to blame her problems on her weight and suggested a diet and come and see me again in a couple of weeks. Next week, severe panic attack on way to school, drove straight to GP surgery and insisted on an appt for that day. Saw another partner who spent an hour and a half with us on a ten minute appt. I didn't know you could get that kind of service on NHS!! Offered a referal for 'counselling' which took so long to materialise that he ended up puting her on TCAs. Psychologist (when we eventually saw one) horrified at drug treatment before talking therapy. Also - she was 16 by then- had to see adult psychologist as no child ones available for evem longer.
Three months of weekly visits led nowhere and psychologist emigrated (for better working conditions?)so the (second) GP offered to see her weekly and put her onto SSRI as TCA didn't suit her.
Finally after two years, she is now happy to go to school again and out wih friends etc and has learned to manage panic feelings.
All down to GP and NOT MH services. Thank goodness some of them take an interest in mental health problems.
Nothing really surprises me anymore about our awful mental health system....and yet, having been through the whole system from the age of 16 (I'm now 35) and now working as a Support Worker, supporting people with mh problems, I see - poorly trained mh staff, nurses, care workers, social workers. I see deadlines, paperwork, statistics, accountability. Lack of funding.... and most of all, lack of human understanding, care, empathy and compassion. We need to start at the very basic level, and that is to 'talk'.
If children that young can suffer from depression, it goes to prove that the problem doesn't only exist in the adult world but is more widespread than we think. Only through education, help, good counselling can we manage depression and gain control over it.
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I'm just interested in trying to establish whether my 10-year-old has depression or not & I don't know what exactly to do to help him.
Ironically I work in a mental health day service (admin support) & frankly, lovely as some of my colleagues are, their professional training is virtually zilch & ongoing training consists of hashed together in-house stuff from the net (I've compiled some of it!!) & books - would I trust them with the care of my child? probably not!
So you see my dilemma is if my nice GP refers my child to the junior equivalent of the day service, then I see no point in that at all.
I'd like some advice!
Also what can I do to help my son myself - I constantly reassure him & try my best to bolster his self-esteem, I've been dedicating time to him on his own for 1:1, I've been figuring in exercise & better sleep patterns, but he's still talking about hating himself.
I don't know what to do.
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Fiona
I am a Primary Mental Health Worker & work with children, young people & their families in the community. Families I have worked with appear to have found a PMHW approach helpful. We take a history of the child's development which includes strengths & 'what works' as well as areas the child and parent/s feel are concerning about the child's emotional well being. As PMHW I would consult with & observe your child in school if this is felt appropriate & would also consult with other agencies. I would encourage you to ask your GP to refer to your son to your local mental health children's service as in my experience you & they together can make a difference with a good outcome. Good Luck.
S
im one of those kids im a little over wight and im scard to do sports because other kids make fun of me !!!! p s im 9
but im really trying to inpress this really really cute guy at school hes my age and his name is noah butb again im scard
im like in a 3 guy thing right now
im so depressed i know you guys think what kind of dupresstion do kids have 1 parents not bonding with them 2 being made fun of at school 3 and thinking diffrently about them selfs (over wight) (disablyed) and stuff like that
remember all this was wrote by a 9 yr old girl i know i can be deep1
i have a b. freind but hes a real jerk to my realitves and his. and i don't beilevein long distance realations.xoxo NOT lol
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