Changing psychiatrist and psychosis team: why is it impossible?
My mam got a new psychiatrist a few years back when she was managing her Schizophrenia reasonably; the previous one retired. Now that her condition has erupted and is mercilessly making life hell for me (because I don’t react to insanity very well) – we’ve had to consult the new psychiatrist. We both confirm that the new psychiatrist is next to useless and is inept; she did not train in the UK but at some oversees place. We now want a new UK-trained psychiatrist to take over, but can we get one? Can we hell! It’s set in stone; once you are under a psychiatrist and they’ve handled your case over years – they become your permanent shrink. That’s according to UK rules! So – even if they delegate consultation to another consultant, the original psychiatrist with her team of “support workers” – stay in charge.
We cannot change our psychiatrist: it’s absolutely crazy! This is a violation of patient’s choice. For one – we did not choose her; she replaced our original one. And if we had known her level of expertise back then – we’d have rejected her without hesitation. Two – we feel utterly deprived of expert medical/mental health advice - since we have no confidence in this so-called doctor and the team she heads - whatsoever.
Can anyone confirm that this is really the case under UK law?
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Please, those in the US, I wouldn't make suggestions because Englands health system does not work like ours. Hopefully Country Mouse wil, chime in.
The core problem I have is the reluctance of the psychiatrist to consider that the dose of my mam's medication is far too high - according to the PIL.
My mother started 2018 at 200mgs of Clopixol Depot (injections). By the end of the year she was at 400mgs; which did nothing to make her symptoms manageable. In fact, my mam complained that the high dose was too much and I can corroborate that it was making her more unstable and seemed to be the cause of her insomnia. The night after her injection – she’d finds it hard to sleep.
Most Patient Information Leaflets for Clopixol – strongly recommends reducing the dose for over 65 year olds. But here is an example that makes the recommendation more explicit. Quote:
“Adults
The usual dose lies between 200-500 mg every 1 to 4 weeks but some patients require 600 mg every week. The maximum single dose at any one time is 600 mg. If you need more than 2 ml of medicine it will probably be divided between 2 injection sites.
If you haven’t received an injection like Clopixol Injection before, a small dose of 100 mg is usually given one week before your normal dose to test how well you tolerate the medicine.
If you have been treated with Clopixol tablets and you are being transferred to Clopixol Injection you may be asked to continue taking the tablets for several days after the first injection.
Your doctor may decide to adjust the amount given, or the interval between injections, from time to time.
If you have liver problems, the level of zuclopenthixol in your blood may be checked.
Older patients (above 65 years of age)
Starting doses for older or frail patients are usually reduced to a quarter or a half of the dosage range.”
Can anyone see - that according to manufacturer's guidelines - my mam is being overdosed? What can we say about the quality of skill demonstrated by the physician here? What magical skill are they invoking to warrant going outside proper use?
Psychiatrists get away with a lot of hocus pocus, because mental health is such an esoteric field. This is why I want to change the shrink desperately; I think this one criminally incompetent.
Yes, we could pay out of pocket for someone else if we could find someone. But OP could do the same. I'm assuming that rule is just a NHS rule. Paying privately you can see anyone you want.
If your mother is not able to engage with this individual there should be a number of options to try; but it does depend on how you're accessing the service. If you'd like to send me a private message and let me know where you are I may have some ideas.
If you're looking for help with advocacy, you can try Mind, or if it's a Trust or Hospital based Consultant there will be a PALS team who will help you with any concerns.
If your mother is acutely ill, there should also be a crisis team you can get in touch with. But do I gather that there is and you haven't been too impressed? What sort of support are you looking for immediately?
I'm sure I don't have to tell you that psychiatric and psychology services are - I can't think how to put it politely so I won't finish that thought.
There is also a difficulty in that transferring from one well established relationship to a new one is *always* going to be difficult. I agree that there should have been succession planning in place, but... dream on, basically.
Is your mother living alone or in any kind of sheltered community?
The system is different but the problem is just as intractable wherever in the world you are, I think. How do you get a rapid, proportionate response to a psychotic breakdown when the person isn't in regular communication with a specialist s/he trusts? Sheesh, difficult.
Meanwhile, take some breaths and hold on to your temper. Do you really think your mother's psychiatrist can't read? When a doctor prescribes something that appears to be contrary to the instructions on the PIL, this is what you say:
"I'm sorry to trouble you, doctor, but it says here that patients over 65 would normally begin with a dose of xx mg and that doses over xy mg may be contraindicated. Could you please explain your recommendation and prescription?"
By the way, if you put it like that to your mother's GP the GP may call and confirm the px with the psych team. The GP should certainly be able to get a rationale for you. Personally, I would expect there to be a perfectly sound rationale which I hope will make sense to you once somebody has bothered to say what it is; but there have been horror stories, ever, and you are not wrong to ask.
Please don't think I don't sympathise - I have met psychiatrists who make me wonder that the NHS's zero tolerance anti-abuse policy ever works at all. But you must focus on what you DO want to happen, and you must recognise that your mother's condition is not straightforward and won't be solved overnight. Not even by someone trained at the Maudsley. Meanwhile, what support do you and your mother have and how is she herself doing?
The question is: did something *else* change, and what investigations have been done?