My Views on the NHS

I might sound very negative here, as clearly NHS mental health services benefits millions of people – providing immense comfort, solace and succour to patients and their families.

I cannot speak for the adult Mental Health services – but as a Paediatrician with an interest in behavioural paediatrics, do come in frequent contact with Child & Adolescent Mental Health Services- and in one word the experience is bad. This is based on my experience of working in 6 different boroughs of the country.

To begin with, the criteria for accepting referrals is so complicated and exclusive that rate of rejection is significantly disparate and high compared with acceptance rate. Parents who chase up referrals are literally told that ‘ the child is unlikely to be accepted as he/she is not suicidal yet! ‘Hearing voices’ is an accepted mode/ ploy often used by paediatricians to circumvent around this unwanted obstacle. I feel sad when this happens.

If at all these kids are unfortunately admitted to Paediatric wards for self harm or attempted suicide, the response to plea for help (from paediatricians) is rather sluggish and often unexpected! The one’s we have serious concerns about are often discharged and the ones of no major concern linger on forever without being discharged from wards. And Paediatricians are protocol bound from discharging unless CAMHS team have made an assessment and certified ‘’unlikely to harm themselves imminently”.

We often wish they were l assessed from an A&E setting, that could actually prevent millions of blocked beds and millions of pounds down the drain every year across the U.K. Often paediatric wards remain pure child minding services, particularly when services haven’t decided where to send the child with difficulties to. This includes the ones with eating disorders and the violent aggressive ones, as there is no clear uniform pathway or services catering to these increasing numbers.

If finally accepted to be seen, these children with severe anxiety, depression, early psychiatric disorders are seen by untrained play therapists, social workers, nurses and only rarely a psychiatrist or psychologist, as such is the heiratchy of care. They are given some sessions and discharged with a letter often repeating what was put in the referral letter or what parents said. This letter does not convey strategies or a plausible plans of action.

Often it is sad that a referral by a consultant paediatrician is not honoured by a reciprocal review by a consultant psychiatrist. This is considering the fact that the major bulk of behavioural patients in the U.K. are dealt with by a paediatrician and a referral is made to CAMHS only when in a dire situation.

I remember one case where a teenage boy clearly showing features of Bipolar Disorder was referred to CAMHS with an urgent phone call to a psychiatrist I knew. To my consternation, referral was rejected after first appointment by a social worker who saw him – as the boy said ‘ I am fine’ to the question ‘ How are you feeling today?’. Even the significant history that his father (divorced) had BPD and would rape his mother in front of his children in a state of mania was not taken into account! This was clearly mentioned in my letter and was the major source of concern for the distraught mother who had brought him to my clinic!

When I spoke to the consultant I had referred the child to, he says ‘sorry my hands are tied, it is in the hands of the multi-disciplinary team that triaged the case, as to who reviews the child!

I was truly appalled.