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Recently we've had a junior doctor with mental health problems living with us. When she arrived, she had been discharged from the psychiatric crisis team where she had been living without a referral to services locally in spite of psychotic symptoms; she had been seeing signs with her name on from the train window, and was so convinced that she should be in prison that I struggled to prevent her going to the police.I asked the GP about an anti-psychotic, but she wanted to wait for the psychiatry review. Three months after arriving, she finally got an appointment. She got the time wrong and missed it. I was gutted, feeling she needed an anti-psychotic and possibly admission, but it's a fine line to tread as a clinician with regard to being pushy. She never made the next appointment. She took a serious paracetamol overdose, was sectioned and commenced on risperidone.I have been reflecting on her care and wondering what could have been done differently. Why did the crisis team not refer her to our local team? In palliative care, we often have patients leaving our catchment area. Lots have caravans in Skeg-Vegas (that’s Skegness for the uninitiated), and we frequently liaise with palliative care teams there to ensure someone will replenish the syringe driver, and to prevent resuscitation attempts if people die while they’re there.If one of our patients misses an outpatient appointment the first thing we do is phone the GP to make sure they're still alive, as the last thing we want to do is to send a snippy letter with details of another appointment to a grieving family. Or were they too poorly to get to the clinic and in that case, do we need to go and see them at home, or even admit them to the hospice?I know that psychiatry services are chronically short staffed – and that’s a scandal – but we are running a specialist palliative care service locally with half the number of consultants and half the number of inpatient beds recommended for our population.And our patient? She’s doing great. She can laugh in a slightly horrified fashion about thinking she was Elsa from Frozen, and that she’d cured every known disease (good job you hadn’t, I said, or that would be me out of a job). She’s starting to think about getting back to GP training and has done some excellent writing of her own about her experience. But I still wonder, did it need to take this long?Becky Hirst is a consultant in palliative medicine
Find out more about the BMA’s work on mental health.
Thank you for writing and glad your friend was fortunate to make her way through and glad she is going back. She will make a better doctor for her experiences
Thanks for looking after her; it could have been any of us. Best wishes to her.
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