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Neuropsychiatry patients victims of barriers to consultant-consultant referral
- Anthony S David (12 March 2006)
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Re: Neuropsychiatry patients victims of barriers to consultant-consultant referral
- Janet A Butler (21 March 2006)
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Anthony S David, Professor Institute of Psychiatry, POBox 68, DeCrespigny Park, London SE5 8AF
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Sir I strongly support Gooderham and others’ call for a review of consultant to consultant referrals. Cases who would benefit from the input of interdisciplinary specialties such as neuropsychiatry are particularly vulnerable if they are prevented. If a consultant neurologist in a neighbouring trust refers a patient to me in the South London and Maudsley NHS Trust, the referral is likely to be “rejected” by the patient’s primary care trust (PCT) unless it goes through the laborious bureaucracy entailed in being bounced back to the local psychiatrist’s community mental health team, via the GP. Many such referrals fall by the wayside, much to the apparent satisfaction of cash-strapped PCTs. So patients with severe psychosis complicating Parkinson’s disease, or depression complicating multiple sclerosis, or somatoform disorders are denied the opportunity for specialist assessment and treatment. Such patients seldom have the wherewithal to complain thanks to their mental illness and cognitive impairment. Trusts cynically avoid the embarrassment of prolonged waiting times since they do not ‘start the clock’ on such referrals until they are “approved” by the PCT. This goes against recommendations for best practice in long-term neurological conditions and patient choice. A solution to this problem will require regional or national provisions above the level of PCTs. Competing interests: ASD is Chairman of the British Neuropsychiatry Association |
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Janet A Butler, Consultant Liaison Psychiatrist Department of Psychological Medicine, Southampton General Hospital, Southampton SO16 6YD
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Sir, I endorse David's comments on Goodesham's article in relation to concerns about provision of mental health care to people with physical illness if consultant to consultant referrals are stopped. Physical illness is a well known risk factor for psychiatric disorder and somatoform disorders will present with features commonly presenting to acute hospital consultants. Provision of specialist psychiatric services such as are provided by Liaison Psychiatry and Neuropsychiatry services enables integrated psychiatric and medical care of such patients. This group is generally poorly served by general psychiatric services, who take referrals from local primary care teams, due to psychiatric and medical services being geographically distant, lack of expertise in either service regarding the interaction betwen physical and psychiatric issues, or the psychological problems not meeting referal criteria for general adult psychiatry teams despite causing major morbidity, disability and healthcare utilisation when combined with the person's physical illness. Consultant to consultant referrals significantly speed up integrated management of such patients and in many cases may be the only way to currently access appropriate mental health input. Competing interests: Dr Butler is a Consultant Liaison Psychiatrist |
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