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PCTs poles apart over depression services

Pulse's investigation into depression services found stark variations in levels of access offered in different parts of the country.

Patients in some areas are seen in a matter of weeks, but in others they may have to wait as long as three years for the therapy they need.

Pulse set out to explore in more detail why GPs describe some PCTs as providing 'abysmal' services, but hail others as 'brilliant'.

Is there a simple solution that could help to solve the national problem of access?

Our investigation found children in particular were let down by extremely long waits for assessment and treatment.

North East Lincolnshire PCT admits children have to wait a year for assessment by the child and adolescent mental health service, and up to two years for treatment. It also admits child psychiatrists are 'not routinely available'.

Dr Hasmukh Jethwa, a GP in Grimsby, Lincolnshire, says it is 'very frustrating' trying to get children with depression seen.

'It takes a long time. If we have someone with mild to moderate depression we try to counsel them in the surgery,' she says.

The trust stresses that a detailed review of access to the child and adolescent service is already under way, with 'the objective to improve access times'.

Dr Derek Hopper, a member of the trust's professional executive committee and a GP in Grimsby, admits the service for children ­ provided by the mental health trust ­ has been 'awful'. He says GPs have been forced to refer children to the general paediatric unit.

But Dr Hopper adds: 'We are looking at rejigging the service completely, at what is available in the community and having children assessed by a multidisciplinary team rather than just the GP.'

Morecambe Bay PCT also admits to long waiting times. Adult waits for psychological treatment in secondary care have been up to three years, although the trust insists new initiatives mean this will be cut to 'no significant delays'.

But GPs in the area have demanded urgent action to tackle the problem.

Dr Richard Johnson, chair of Morecambe Bay LMC and a GP in Dalton-in-Furness, complains access is abysmal.

'The psychological service is closed to new referrals and has been for the last year. There is nowhere for patients to go.'

Dr Johnson adds: 'We really need them to open the psychological service and provide a service that meets the needs of these patients.'

Morecambe Bay PCT says under the service redesign there will be new referral criteria for psychology services in second-ary care and new primary mental health care teams with 13 graduate workers.

Peter Clarke, the trust's director of mental health, admits: 'It was utterly unacceptable, which is why a year ago we launched this major process. Historically there has been a lack of primary care resource, which means secondary care has been overwhelmed and we have had these waiting lists.'

Meanwhile, in other areas of the country, change has already brought dramatic improvements in access to psychological therapies.

In Lincolnshire South West teaching PCT, GPs have described the introduction of practice mental health workers to carry out triage as 'brilliant'. Even better, the savings on antidepressant prescribing are being ploughed back to em-ploy more counsellors and therapists.

Dr Andy Jones, a GP in Stamford, Lincolnshire, says assessment is now carried out within two weeks and treatment normally within four.

He adds: 'The mental health worker has had a dramatic effect on the service. We use antidepressants far less because there is no longer a waiting list and that's resulted in cost savings.

'The mental health worker has just been simply brilliant.'

Dr Rita Aggarwal, a GP in Ramsay, Cambridgeshire, is also very satisfied with her local service since her practice secured funding for a mental health pilot.

Under the scheme, being rolled out more widely, a graduate mental health worker is based in the practice part-time.

'It's a lot better. If you can wangle the funding it's the ideal system. It takes the pressure off one of the hardest bits of our jobs,' Dr Aggarwal says.

So what can other PCTs across the country learn from these experiences?

Dr Chris Manning, chief executive of Primary Care Mental Health and Education, wants to see more resources moved to primary care and more GPSIs.

Dr Manning says: 'New ways of working must now mean, especially after the latest White Paper, a commitment to drawing as much mental health into communities and primary care as possible and the urgent development of GPSIs in mental health ­ as maxi whole-systems GPs, not just mini-psychiatrists.

'We need to think about skilling-up all GPs in mental health competencies and not just expecting new and expensive workforces or novel interventions.'

Dr Malcolm Skinner, a mental health adviser to the NHS Alliance and a GP in Swaffham, West Norfolk, agrees: 'Using people who can do mental health assessment in primary care is the way forward.'

Solutions are emerging at last, but for some trusts a long journey lies ahead.

PCTS at either end of spectrum

Morecambe Bay PCT

  • Psychological service closed to new referrals, apart from exceptional circumstances
  • Assessment for psychological therapy for adults takes up to three months
  • Waiting times of up to three years for adults to have psychological therapy in secondary care
  • Trust introducing new initiatives and changing referral criteria in bid to cut waits

Lincolnshire South West teaching PCT

  • Assessment for all patients with mental health problems within two weeks by mental health workers based at practices
  • Patients triaged for treatments such as counselling, psychotherapy, consultant referral or group work
  • Most patients start a form of talking therapy within four weeks

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