WE are health professionals who are increasingly concerned and disappointed about the misrepresentation of Scotland’s NHS mental health services in our media. There is confusion about emergency mental health care, in particular for people in suicidal crisis, with the 18-week waiting time target for access to psychological therapy. This is undermining public trust in the Scottish NHS and can dangerously discourage people in crisis from seeking the appropriate help they urgently require.
A prime example was the discussion which took place on BBC Scotland’s Debate Night on October 9. The question from the public – “Suicide rates are increasing in Scotland. Is an 18-week referral target adequate for those experiencing mental health problems?” – was confusing emergency mental health crisis support with the 18-week waiting time for access to psychological therapies right from the outset.
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Christine Jardine MP then gave the example of her husband many years ago receiving the indicated crisis support on the same day as attending his GP, and then asked “what would have happened had he to wait 18 weeks for this support?”. This creates the impression that the present mental health care provided by NHS Scotland would leave patients in (suicidal) crisis for 18 weeks before offering help.
Whilst the questions from the audience demonstrate the level of public confusion, the BBC however cannot be excused from doing their homework properly when preparing for this programme.
The 18-week waiting time target for access to psychological therapies is a completely different issue to crisis support, and the two things must not be confused. There is a very good clinical reason for the 18-week target. Many psychological/psychiatric problems are “self-limiting” in nature and often resolve within four months without specialist psychological help because
(1) people still have supportive social networks, and (2) most people are genuinely psychologically resilient. For some psychological problems, for example acute trauma after accidents, a psychological therapy before three months past trauma is even contraindicated.
For mental health crisis situations the Scottish NHS has a well-functioning and integrated system of support. 80% of mental health presentations are treated within primary care and community settings. People experiencing suicidal and other mental health crisis (or their family members, friends, carers) can access a number of crisis support systems across statutory and third-sector organisations. They can contact their GPs, telephone helplines, drop-in centres, NHS24, A&E departments etc. Based on their initial contact, this will then be triaged with secondary support from community adult mental health duty teams, children and adolescent mental health service duty teams, intensive home treatment teams and/or with assessment at the nearest mental health inpatient unit and if necessary admission to hospital.
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All crisis support services work in an integrated fashion and in most cases are able to provide support on the same day of initial contact by the person/carer. The safety of a person presenting in crisis is ensured on the day of presentation. The misrepresentation of crisis intervention as being provided only after up to 18 weeks is appalling and dangerous.
If a trauma, acute anxiety, depressive episode, adjustment disorder, etc has not resolved itself within four months, affected individuals may need access to specialist psychological therapies, but there is a balance with avoiding “over-medicalising/psychologising” what is often part of normal life experiences. NHS Scotland has a well-developed integrated mental health service, which is able to provide access to psychological therapies within the 18 weeks target for the majority of people. Unfortunately this is achieved not for the target 90% of adults, but in the latest statistic to 78.8%, which is nearly eight out of ten people referred, and compares well with other countries including NHS England.
The depiction of our Scottish NHS mental health services as failing Scotland’s population is grossly distorted. It is also an insult to hard-working NHS Scotland staff. We have a world-leading integrated public health and social care system in Scotland, that is aligned with the founding principles of the NHS and universal healthcare provision, and must be defended against any threat of privatisation and disintegration.
The misrepresentation of emergency mental health crisis support as being subject to up to 18 weeks’ waiting time is dangerously undermining public trust in Scotland’s NHS, and we ask the BBC to clarify this for the sake of public education and patients safety in future.
(The signatories are acting in a private capacity and any opinions expressed are not necessarily those of the respective NHS health boards)
Ulrich Fischer, consultant clinical psychologist, AFBPsS; Dr Colin Brown, FRCGP; Mohrag Fischer, RMN; Dr Ian Grant, FRCP(Ed), Retired Consultant, Intensive Care; Dr Chris Johnstone, Retired General Practitioner; Dr Stephen McCabe, FRCGP; Dr Paul Miller MBChB, MRCGP; Dr Anne Mullin FRCGP; Dr John Riley, Physicist; Dr Marcel Strauss, Consultant Radiologist; Dr William Wilson, Community Pharmacy Contractor
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