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GPs are concerned that moving a free confidential therapy service to people referring themselves has stopped vulnerable people from accessing it.
When Jersey Talking Therapies was launched in 2014, islanders seeking help with their mental health were referred to the service by their GP, but from the beginning of 2018, people were able to refer themselves to make it easier to access.
However, while recognising that more people are using JTT, GPs fear that the self-referral default may act as a barrier for some.
Writing to a Scrutiny Panel of politicians tasked with investigating mental health services, the Primary Care Body, which represents GPs, said: “JTT waiting times remain very poor and seem to have worsened since 2018.
“Having previously been a health professional referral-only / gatekeeping service, it now only accepts self-referrals which can increase access, but there are concerns that not accepting GP referrals and requiring specific ‘opt-in’ reduces access to people with learning difficulties, communication difficulties (e.g. autism), non-English speakers and many with anxiety and depression where the conditions limit motivation and confidence to approach services directly.”
GPs are also critical of the decision to close down JTT during the first lockdown in 2020.
“During the initial lockdown, Jersey Talking Therapy was closed down - this was very disappointing and difficult to understand as if there is any health service most suitable to virtual/phone delivery psychologic services are surely it,” the GPs said.
Pictured: Lockdown and periods of isolation during the pandemic has impacted some islanders' mental wellbeing.
“This abandoned the very people to be most affected by the lockdown and caused significant harm.
“Although we don’t have the figures, one would assume that this significantly worsened the already lengthy waiting times for psychological treatments.
"While wider mental health services continued, they were disrupted and moved to telephone-based care. This was understandable given the context, but not ideal for vulnerable patients.”
Asked whether they felt the pandemic had changed the need, or the requirements, for mental health services in Jersey, the Primary Care Body said: “While for some the lockdown and ‘work from home’ periods have been beneficial for their mental health for many others being stuck at home without the normal home/work boundaries and lack of social contacts has been detrimental.
“Some, especially older vulnerable people, remain isolated at home due to fear of the virus. Depression and anxiety disorders directly linked to the experience of the pandemic have been common but it’s difficult to ascertain from the experience of individual GPs the change of prevalence from baseline: objective data from mental health services would be helpful to clarify this.”
There have been positives, the GPs say, with the Listening Lounge being “a considerable improvement” in mental health provision for milder conditions and to fill the gap whilst patients wait for JTT.
They add that there is a “perception” that CAMH service has improved over recent years and the availability of adult ADHD services has also improved and had a “positive impact on those newly diagnosed and treated for the condition, although the waiting list is lengthy.”
Offering their thoughts on where mental health services could improve, GPs identify a number of areas:
Better continuity of medical and support workers: current high turnover of staff worsens patient care and confidence.
Shorter waiting lists for outpatient appointments for adults and children including dementia services.
Both in-hours and out-of-hours crisis responsiveness and provision: it is often difficult to get hold of the right person at the right time and willingness/incentive to get involved is variable. Refusal to visit patients at home because “we don’t do home visits” even when patients feel unable to leave their house. Relying on telephone assessments when face-to-face is more appropriate or has been specifically requested. Patients end up at the Emergency Departments which is less than ideal. There are some examples of good practice, but unfortunately seem to be too rare. There is a lack of out-of-hours provision from CAMHS.
More immediate provision of psychological treatments to improve mental health more speedily and effectively, reduce the risk of deterioration and avoid overprescribing of antidepressants.
Better interdisciplinary working between mental and physical health teams. For example, referrals for patients with ‘delirium’ are often rejected by mental health but may need significant mental health input to manage. There is a desperate need for both an experienced psycho-geriatrician and likewise a specialist geriatric team at the hospital to provide holistic patient-centred care
Consideration of better engagement between lower-level psychology services and GP practices. At least one practice has a mental health practitioner providing immediate care for mild to moderate disorder but funding for this is not guaranteed for the long term - sustainable funding for such schemes would be beneficial
Generally, referral systems are poor and seems to be designed to filter out patients rather than assess them first and then provide appropriate care: more proactive approaches are needed.
Improved communication from mental health to GPs especially around crisis situations when it is vital GPs know what has happened in a timely manner. Lack of appropriate communication across the service is a recurrent complaint.
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