I could not welcome the Schizophrenia Commission’s report, published today, more.1
I am a section 12 approved retired GP. I have decided that I no longer wish to assess patients as to whether they should be detained against their will. The majority of assessments I am asked to do are for 28 days of assessment. My experience is that due to bed cuts, a local bed is very often not available. The patient therefore starts his or her assessment far from home. There then seems to be a low threshold for transfer to a secure unit, then transfer to a more local bed follows.2 As a result the patient, often suffering from schizophrenia, is looked after on a temporary basis by several psychiatric teams none of which seem to be making a full assessment. I will be asked to see someone towards the end of this 28-day period and no member of staff can tell me their ‘story’, stating as a reason that the patient has only recently arrived.
If a patient is not to be detained, reliance has to be placed on the crisis teams. Patients often do not engage with these community-based teams, complaining that they see a different member of the team on each visit and resent having to start their painful story from the beginning each time.2 There seems to be a lack of engagement from the crisis team’s side too, claiming as a reason that the patient doesn’t really want to see them.
I have therefore been left choosing between a rock and a hard place.
Inpatient units are far from satisfactory, but it is important that they should be improved rather than cut, hopefully enabling them to offer the ‘good care delivered by kindly, compassionate practitioners’ referred to in the report, and to look after more disturbed patients rather than sending them to secure units. Secure beds could therefore be reduced as the report suggests but the current general adult psychiatric bed shortages are part of the problem.
- © British Journal of General Practice 2013