NHS

Day 468

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As I look through the list of organisations that offer help for the mentally ill, I find that most of the work is being done by voluntary bodies like CALM, Mind, Papyrus, Rethink, Depression Alliance, Grassroots, MHFA(Mental Health First Aid), Samaritans etc.

Within the NHS I am sure there are a lot of individuals who care deeply for the mentally ill but as an organization, it is ineffectual for the majority of patients as is evident from many experiences including this anonymous author of today’s article in the Guardian.

Policies are written without any funding to help with their implementation. Many services that have been in existence for a while are being discontinued due to shortages. Inappropriately trained personnel are put in positions of responsibility eg. Occupational therapists as members of Home Treatment Teams. The services are configured more with the idea of saving money than with patient’s best interest in mind. Mental health services have been at the bottom of the list of priorities for so long that they are now truly struggling to maintain even the very basic level of care.

A ‘signpost’ is something that serves as a clue or indication. When Saagar was ill, only the Samaritans were mentioned as part of the Crisis plan. No other organisations were mentioned by the psychiatrists or the GP in terms of websites to guide us on how to look after someone who is depressed and I wasn’t smart enough to find one myself.

If someone asks me for help and I am unable to help them, I can at least ‘signpost’ them in the right direction. We all can. Something as simple as that can save a life. Or two. 

 

 

Day 464

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If I worked as an anaesthetist for one day a week, would I be good enough to be called a ‘Consultant’? Would you trust me to anaesthetise you? After taking away annual leave/study leave/ professional leave and sick leave, I may have 40 working days per annum. That adds up to about 320 hours per year. Is that enough to be an expert?

According to Malcolm Gladwell the author of Outliers, it is a myth that genius is born. It is made. He claims that Mozart and The Beatles are not so much innate musical prodigies but grinders who thrived only after 10,000 hours of practice. By that definition, it would take 31.25 years for those who work 320 hours per year to get really good at what they do.

Some Honorary Consultants in Psychiatry in the NHS have a clinical commitment of only one day a week. The rest of the time they do research and other non-clinical work. Even if they have 10 years of clinical experience as a consultant they would still need 21 more years to excel in their field. That would be roughly the same time they would be ready to retire. Is that fair on patients? Should that even be allowed to happen?

Do those 8 hours of clinical work include documentation, dictations, clinical meetings, talking to relatives and trainee supervision? How does this work? It doesn’t.

In principle, decisions are taken in the best interest of the patient. In reality, decisions are taken based on funding, which pot the money comes from, strict compartmentalisation, which segment of a service looks after what, which day of the week it is and what type of contract the doctors are on.

I am sure everyone does their best within their limitations. But as long as health is treated as a ‘commodity’ and patients as ‘customers’, we cannot get it right. NHS is now so far from what it was set out to be. I have always been proud to be a part of it and stood up for it when people criticised it. I believed that they didn’t realise how lucky they were to have it. But after seeing the way Saagar was treated, I feel deeply betrayed by my own people.

Day 461

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‘Parity of Esteem’ is best described by The Royal College of Psychiatrists as: ‘Valuing mental health equally with physical health’.
More fully, parity of esteem means that, when compared with physical healthcare, mental healthcare is characterised by:

  • equal access to the most effective and safest care and treatment
  • equal efforts to improve the quality of care
  • the allocation of time, effort and resources on a basis commensurate with need
  • equal status within healthcare education and practice
  • equally high aspirations for service users
  • equal status in the measurement of health outcomes.

At the Coroner’s court, when the (Honorary) Consultant Psychiatrist was asked why he did not have a conversation with me, the patient’s mother, about his diagnosis of Bipolar Disorder when he made that diagnosis , he said that was because the patient ie. Saagar was very averse to me (his mother) at the time. It is eminently possible that his hostile attitude was a symptom of the illness.

However, the doctor felt comfortable sending him home to live with me.

If Saagar would have presented with a Hb (Haemoglobin) count of 5 (normal being 14-16) due to blood cancer, would he have been told his diagnosis, put on medication and sent home? No. The family would have been informed and educated about the illness and given clear instructions on a possible hospital admission and where to go if things got worse. The patient would have been offered counseling services to deal with this potentially life threatening disorder. They would have informed them about the 5 year or 10 year mortality associated with the condition and the expected desirable and undesirable effects of the medications.

With all due respect to the Psychiatrists who work under tremendous constraints and do a lot of good work everyday : if they, as custodians of the mentally ill, are unable to give mental illness the parity of esteem it deserves, how can we expect anyone else to?

Day 454

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“I am sorry that I did not refer him back to the Community Mental Health Team but at the time of my assessments in September and October I did not feel this was clinically necessary”, said the letter from the GP.

I am sorry but I think this is ugly.
I am sorry but I don’t think you are sorry.
I am sorry but using the word ‘but’ is a justification and not an apology.
I am sorry but your clinical judgement was clearly flawed.
I am sorry but this is not good enough.
I am sorry but I might have to change my mind about taking this further before others come to harm.
I am sorry but this statement does not give me any idea of your understanding of the damage caused by this mistake.
I am sorry but it also does not indicate that any lessons have been learnt for the future.

When an apology is heartfelt, it comes through clearly.
If he had said, “At the time I did not think he needed a referral. I am really sorry I didn’t refer him back.” it would sound more real.

Is the litigious nature of medicine preventing us from connecting at a human level? Should we need lawyers to find the truth in a case like this? Are we not capable of looking at ourselves and our systems and figure out the deficiencies?

An apology is a regretful acknowledgement of an offence or failure. Nothing more. Nothing less.

Definitely no ‘buts’.

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Day 448

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Just before concluding Saagar’s inquest the coroner asked me, “Do you think your son was treated differently because you are a doctor?” At the time I could only think of the Daksha Emson Inquiry which concluded that “doctors may end up being treated less effectively than if they were ‘ordinary’ patients.”

In my experience as an anaesthetist when a colleague or their family members come into hospital to have a baby or an operation, however minor, they are approached as ‘high risk’ patients. They somehow seem to bring trouble with them. Red flags go up automatically. As far as possible they have a consultant anaesthetist and surgeon looking after them as a matter of professional courtesy. It doesn’t incur any extra cost. Courtesy often doesn’t.

Saagar was scheduled for a minor surgery at my hospital in February 2011. One of the most senior and highly respected surgeons in the country put him first on his list and a brilliant consultant colleague anaesthetised him. I did not ask for or expect any of this but was very grateful for it.

So, I am not sure how to answer that question. Was Saagar treated differently because I am a doctor?

Maybe the Honorary Consultant psychiatrist who made the diagnosis of Bipolar disorder assumed that I would know all about it. Maybe that is why he did not speak with me or Saagar’s father even once. Maybe the GP assumed the same. I knew as much about mental illness as an average psychiatrist would know about anaesthesia. Those assumptions are baseless.

Maybe Saagar would have received better care in a smaller town. Years ago, when I had decided to move from Belfast to London, one of my colleagues had commented, “You are going from being ‘a rich somebody’ to ‘a poor nobody’”. He was right.

Well. I wish he could have received the treatment that every single person deserves. If that would be the case I would not be the author of this article in the Huffington Post : Suicide – The Silent Epidemic.