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The consequences of an underfunded mental health system

We hear a lot anecdotally about increased thresholds for mental health referrals. In 2016, we reported some commissioners insist that the patient has to have had suicidal thoughts before accepting a referral.

This has never been about making referrals more appropriate, as is claimed. This is about overstretched services being cornered into having to protect themselves from work as a result of years of underfunding of mental health care.

And despite all the Government’s insistence that they are prioritising mental health spending, from speaking to GPs I have no doubt things haven’t got better since then.

For GPs, this affects their ability to give patients the treatment they need. It also requires plenty of time to ensure the referral is right for fear of it being rejected.

If a patient who later dies by suicide doesn’t meet referral criteria, there is something rotten in the system

The case reported this week of 16-year-old Sam Grant – which followed the similar case of Lewis Doyle reported last month – shows that these reduced thresholds are not just academic, or a case of GPs worrying about themselves. Like so many things around GP workload, decisions to cut referrals have real consequences for patients.

We will never know what would have prevented Sam and Lewis dying by suicide. But we do know that if a patient who later dies by suicide doesn’t meet the referral criteria, then there is something rotten in the system.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at