Since 2013, the NHS England constitution has included a commitment to “improve, prevent, diagnose and treat both physical and mental health problems with equal care.” Subsequent NHS commissions have set targets for equivalence between mental and physical health.
For example, the NHS mandate for 2018-19 states that measurable progress must be made, particularly for people in vulnerable situations. The NHS’s five-year forecast for 2014 included a commitment to achieving equality by 2020.
In 2019, NHS England published its long-term plan. This meant a renewed commitment that mental health services would grow faster than the entire NHS budget, as well as the creation of a new dedicated local investment fund worth at least £2.3 billion a year by 2023/2024 to “continue to expand services and provide faster access to public services.” and medical institutions. Mental health crisis services for both adults and especially children and young people.”
But how close are we to the equivalent rating? Fast forward to the end of 2023, and the mental health system is suffering. In October, health leaders called for action to address the “national mental health emergency.” They said the neglect of mental health services in the community and the lack of sufficient hospital beds had led to long emergency department wait times.
Dr Sanjeevan Somasunderam is a consultant psychiatrist working in the mental health team at Southwark North Primary Care. For the last twelve years he has worked as a consultant in South London and Maudsley NHS Foundation Trust. This is his December diary of a typical week on the mental health frontline.
Monday
Every morning, we first review recommendations received the day before or over the weekend. This is one of our most important meetings as we decide whether we can give advice or whether we need to examine the patient, and if so, how quickly.
GPs have relatively little time for patients and some are less confident about mental health issues than they are about physical health. Therefore, we must check whether there is enough information to make a decision in each individual case.
I was accompanied at today’s meeting by two interns, our resident, our clinical dispatcher, a rapid response manager, and two on-duty staff.
We receive approximately 300 referrals per month, and the decisions we make during this time are critical to patient care. We have determined that one of today’s cases requires urgent attention and our dedicated First Responder will attempt to resolve it within the next 24-48 hours.
I spoke to a patient’s mother this afternoon to hear about her progress with a proposed new medication and am preparing a presentation to the Nexus GP group next week on ‘Managing Personality Disorders in Primary Care’. One of the most important parts of my role is my relationship with GPs.
In addition to regular contact with patients, I meet with them to discuss their difficulties and educate them. These relationships are critical to our work.
Tuesday
I spend the morning meeting with colleagues, discussing cases and helping each other decide how best to care for each individual patient. My appointments began with clinical supervision from our physician assistant. We reviewed their clinical cases and discussed their developmental needs. We then attended the daily review meeting and reviewed the eight cases we had received since yesterday.
I then organized a meeting of my interdisciplinary team in which the doctors brought forward cases such as questions about medications, access to therapy, and the need to consider leaving work. Today there is a psychologist present, medical students have come to us.
Team decisions are stronger and it is important that practitioners feel they can practice autonomously, but with guidance when necessary. I do not take a controlling approach because it inhibits independent thinking and development of practitioners.
I then met a GP who wanted to discuss a case he wanted to refer. These conversations with primary care physicians help increase their knowledge about mental health issues and ensure patients get the help they need.
I spent the day visiting my clinic. I enjoy meeting people in person and understanding how they feel. Today I had a new patient and three follow-up appointments. Diagnoses range from bipolar disorder to borderline personality disorder to anxiety disorder.
The initial appointment lasts one hour and we collect a psychiatric history, a mental status assessment, a physical health examination, and a review of medical records.
Wednesday
When people think of mental health care, they often think of people spending months in hospital wards or, worse, in Dickensian asylums. If someone is in crisis, is a danger to themselves or others, or is unable to care for themselves, it is best for them to stay briefly at one of our locations.
We are of course seeing an increase in demand for residential care services, but we care for the majority of people in the community.
My visit this morning made that clear. I visited the home of a young man with a nurse who had not left his bedroom (except to go to the toilet) for over five months.
He also has diabetes, which he struggles with. This was the third time I visited it. When I first came to visit he spoke to me briefly through the door, today he didn’t want to say anything.
I will continue to try to contact him and discuss with mental health social workers whether there is a case for a mental health assessment. The decision to hospitalize a person against their will should never be taken lightly, and we must provide evidence that they pose a risk to themselves or others.
More positive news: I attended a meeting this afternoon to plan a patient’s transfer to a community mental health team and spoke with the GP to advise him on the patient before spending some time planning an upcoming meeting to be led by the community consultants in Southwark.
Thursday
Today is my weekly professional development day. When you first become a consultant, the real learning begins. One of the reasons I wanted to work in South London and Maudsley was because I thought it would be a great place to develop as a psychiatrist.
One of the biggest changes I have seen at the Trust over the last twelve years is closer collaboration with GPs and primary care services. One of the most important skills of a consultant is our ability to build good working relationships to further improve patient care.
This afternoon I was talking to a colleague who I have been looking after for several years. As with any job, it’s helpful to have a place to discuss problems and make plans, and it gives me great pleasure to help someone grow in their role.
15 new recommendations today. One of them was referred to him by his family doctor after a serious assassination attempt.
Our first responder will contact you within the next 24 hours to complete a full assessment.
The workload for me and my team is large and can often be quite reactive. We need to be able to work flexibly when a situation requires an immediate response.
At the end of each day, I try to take time to plan for the next day so that we can always provide our patients with the quality care they deserve, even when hospital and community services are overwhelmed.
Friday
We had 12 new referrals today and I saw a new patient and saw two others. My patients suffer from a variety of illnesses, and the patients I saw today were diagnosed with borderline personality disorder, anxiety, and functional neurological disorder. I also spoke with a fellow primary care physician about treatment options and crisis situations for one of her patients.
I also had a meeting with the security team regarding a woman we previously knew. The team suspects that she suffers from a factitious disorder (formerly known as Munchausen syndrome).
They suggest that psychological therapy would likely benefit her, but she refuses treatment and focuses on medications that have not helped her in years. After discussing the case, we decided to reintroduce her into our work and re-evaluate her.
Today we said goodbye to the current group of doctors in training. They are some of the best we’ve ever eaten and after work we all go out for drinks to thank them.
Looking back on the past week, I am reminded of how much of a team effort it is, both in terms of clinical care and the support we give each other to keep going every day. I am extremely grateful to our administrative team, who are working under enormous pressure to cope with the volume of referrals we receive.
Source: I News
I’m Raymond Molina, a professional writer and journalist with over 5 years of experience in the media industry. I currently work for 24 News Reporters, where I write for the health section of their news website. In my role, I am responsible for researching and writing stories on current health trends and issues. My articles are often seen as thought-provoking pieces that provide valuable insight into the state of society’s wellbeing.