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GPs abandoned on complex mental health cases

By Lilian Anekwe

A Pulse investigation has revealed GPs are increasingly being forced to deal with complex mental health cases without adequate specialist support as a result of policy changes and years of underfunding.

GPs are being left to treat patients with mental illnesses and personality disorders classed as ‘moderately severe', because of a decision to require mental health specialists to focus heavily on psychosis and other severe illness.

A survey of more than 400 GPs – conducted for Pulse by doctors' mobile communication company Pearl Medical – reveals more than half have had patients they referred to community mental health teams (CMHTs) bounced back on the grounds that the patient was not ill enough, or the CMHT was ‘not the appropriate provider of care'.

Professor Andre Tylee, professor of primary care mental health at King's College London, told Pulse there had been a significant shift in policy over the past 10 years, with CMHTs focusing increasingly on patients with severe mental illness, such as psychoses.

‘The money has been shifted to more severe mental illness-focused services and away from mainstream community mental health care,' he warned.

The survey of more than 400 GPs is the first instalment of a series of reports on mental health services. Pulse has also learnt of a series of hidden cutbacks, and found that GPs have been forced to manipulate the system to get patients treated.

A quarter of GPs said they did not receive adequate support from their local consultant psychiatrist the last time they requested it, and a third rated the support by their local CMHT as either poor or very poor.

Patients with depression and personality disorders often appeared to be caught in the gaps between care services. Only 1.5% of GPs surveyed said their primary care organisation provided a dedicated service for patients with personality disorders.

Dr Alison Munns, a GP in Stevenage, Hertfordshire, said her CMHT had refused to see patients with personality disorders she had referred, on the grounds that they were ‘untreatable'.

She added: ‘The service is configured entirely for the needs of those with psychosis and responds adequately to that. Those patients who fit the CMHT's definition of severe mental illness are well catered for, but there are plenty of people I consider to have significant mental health issues who are bounced back, unsupported, and at risk of suicide and self harm.'

One GP in south Lincoln-shire said: ‘Here you can see extraordinary cases of patients who seek help often getting red-carded by services as they cannot cope.'

The Department of Health defended its mental health record, singling out health secretary Alan Johnson's announcement of £170m of new money for the expansion of psychological therapies last year.

A spokesperson said: ‘As the programme rolls out, all practices will have access to them, with an estimated 900,000 people benefiting by 2011.'

The survey findings The findings

82% of GPs have had referrals bounced back by CMHT
33% say support provided by local CMHT is poor or very poor
43% feel mentally ill patients are at risk of harming themselves or others


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