I only know what I heard and read on the BBC, so it may not be the whole story, but it’s so sad and upsetting that I’m going to stick my neck out.
Edward Mallen, who was only 18, had been battling with depression and, tragically, took his own life in February 2015.
He had seen a GP two weeks before his death and had given consent for his parents to be told of his suicidal thoughts, but they were not told.
Why did the GP seek, and obtain, permission to inform his parents, but then fail to inform them?
The GP did, however, contact the local NHS Foundation Trust crisis intervention team and recommended, rightly under these circumstances, that Edward should be seen within twenty-four hours. But, unfortunately, ‘a triage mental health nurse who spoke to Mr Mallen on the phone said a five day wait was appropriate as he did not think there was a significant risk.’
How can it be that a nurse, merely as a result of a phone conversation, has the authority to over-ride the GP’s recommendation?
(It’s unclear from the BBC report whether it was the GP or the mental health service, or both, who didn’t inform the parents.)
The Assistant Coroner said ‘Edward Mullen had fallen through cracks in the system and there had been no continuity of care.’
That’s the problem. Why had there been no continuity of care, and who should have provided it? Presumably the GP.
The bereaved father said: ‘The hearing today confirmed what I suspected was the case, that there are deep structural inadequacies across the health system with regard to mental health.’
He very decently blamed only ‘the system’ saying it was ‘not really fit for purpose.’ But a system such a health service is only as good as the people who work in it. Being faced with a suicidal youngster who had consented for his parents to be told, of course they should have been told, and straightaway. Then close follow-up should have been arranged – whether the doctor was officially on duty or not – until this poor boy was safely in the hands of specialists.
It may not have made a difference but, as a Trust spokeswoman said, ‘The Trust didn’t do everything that could possibly be done…we must therefore accept some responsibility.’
In similar vein is the account, also reported by the BBC, of the case of Julie Bignell who had a three month wait to see a psychiatrist.
… I took an overdose, because I felt that nobody understood the way that I felt. It wasn’t…that I wanted to die…I just couldn’t cope with what was going on in my mind. Nobody could understand me, and I couldn’t understand me, and I wanted somebody to help me. Well, the waiting time to see somebody…just increased the anxiety, the depression.
It’s unacceptable to have to wait so long to see a psychiatrist, and there’s a call to set a twenty-eight day target for access to mental health services. But what about the GP in the meantime? Could not he or she have offered to see this patient – and I apologise if I’m mistaken – once a week for an hour’s session to listen to her problems and, if necessary, start empirical treatment with an antidepressant or anti-psychotic drug? Any GP worthy of the name should be capable of doing this. And surely, in case of doubt it’s possible for the GP to confer with a specialist on the phone for advice on drug treatment in the meantime?
Why doesn’t it happen? It is because many GPs are part-timers? Or is it because they feel they’re not up to the job? Or have guidelines and the Quality and Outcomes Framework (QOF) hamstrung doctors so that they can’t take responsibility for their owns decisions?
By the way, what is the QOF? It’s a voluntary system started in 2004 which rewards GPs for carrying out work which any self-respecting GP would do anyway, in my view.
Let’s see what the current QOF has to say about mental health problems. To start with it says this:
It is recommended that patients receive health promotion and prevention advice appropriate to their age, gender and health status.
How condescending. Do they think GPs are lazy or stupid? It gets worse. This is what the QOF says about depression:
10 points will apply if 45-80% of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March have been reviewed not earlier than 10 days after and not later than 56 days after the date of diagnosis. (Slightly paraphrased.)
Are we playing a computer game? Suppose the GP decides the patient needs to be followed up in a week rather than ten days? Then he misses the 10 points and an extra fee! No wonder there have been calls for the QOF to be scrapped.
One of the great satisfactions of being a general practitioner used to be that you treated the patients to the best of your ability as you saw fit. You didn’t have or need anyone looking over your shoulder in effect telling you what to do or withholding pay if you didn’t do it. No wonder British general practice is in a crisis and failings in the system lead to tragedies such as those mentioned in this post.
© Gabriel Symonds