We had a meeting with our crisis team a couple of weeks ago. There is a general perception that they don’t like taking referrals for over 65s. It has increasingly developed into something of an ‘us and them’ situation so an attempt at some kind of reconciliary face to face meeting was planned.
Personally, I’ve had a few problems in referring. Firstly, they don’t accept any referrals for anyone with any kind of organic mental illness namely dementia. The explanation (although I never actually knew this until last week) is that no-one in the teams have any experience or knowledge of working with ‘these kinds’ of mental disorder.
Even with functional disorders, the input has been more than patchy. Certainly, I’ve had less than helpful responses to requests to refer – even within the ‘just passed 65 with no sign of dementia’ type of situations.
What was actually explained at the meeting (which in some ways helped but in other ways didn’t) is that they receive no funding for catering to the needs of over 65s so any referrals that they do take from us are just as ‘favours’.
I was interested that the explanations were not about ‘providing better services to the population’ or managing more appropriately crisis situations in the community to avoid hospital admissions but rather in terms of ‘doing your team a favour’. I mentioned this in the meeting. One of the psychologists later told me that he thought I might have been a little too ‘emphatic’ in my approach. I love our team psychologists!
Nothing actually irritates me more than this type of attitude though as it seems to have removed the actual purpose of the work that is being done and reduces the entire service the Trust provides to a professional-led structure rather than a patient-led need.
Of course, this raises so many problems with the an institutional discrimination with the service that it shouldn’t be allowed to pass – but it does and it has.
Why somebody should have greater access to a service before their 65th birthday when the need can be exactly equivalent one day after seems to be a particularly short-sighted way of dealing with issues but it is also one of the reasons I am so eager to remain in this specialist team – so that these discrepancies are consistently challenged at an organisational level.
I know I am being a little one-sided and perhaps unfair but it feels sometimes that we are as much fighting within our trust for services as fighting together for the common good.
Such is the way in specialist services sometimes. And so I am free to argue on as long as I am respectfully argumentative and am able to retain an awareness of how far to push and when to stop.
This report then, published in the last week of the existence of the Healthcare Commission (which is consumed tomorrow, into the Care Quality Commission) which states that older people are often excluded from some of the mental health services which are available to working age adults hit close to home.
the study showed older people were often unable to access the full range of services, including: out of hours services; crisis services; psychological therapies; drug and alcohol misuse services.
This reflects my own experiences so strongly that I had to check to see which trusts were surveyed for the research. In fact, these points ally closely with our experiences
In general the report makes for interesting reading but interesting reading is only useful if it leads to changes and effecting of change across the board.
I was glad to see the study published, not least because it expresses similar experiences that hopefully can be challenged even more effectively in the future to provide a more equitable and cohesive service for all the members of the community that we serve.