first contact -with the GP

Make a written record of what you have observed. Keep any written material that looks odd.

What to do next depends upon whether family member agrees to see the GP. If so write a letter to the Gp with your observed record to be seen before the appointment but not to be disclosed as from you.
It is now often the case that your GP will pass on any first contact you have with the GP, to the local Community Mental Health Team member - even if that first contact may be in a few days time. Ask him/her for the him/her qualification and grade of the staff member who will be the first Team visitor.

Next - With the Mental Health admission service or the Community Teams.

First and Most importantly, at first illness, before you meet the specialist community team get famiiar with this- the Care Programme Approach protocol [CPA}

It is 'where and when' you get yourself registered with the local Trust mental health teams as the carer - to be part of all decisions about your family patient.
You should intrude with your views at all the steps within the Care Programme Approach before any discharge plan is accepted by you - as the carer.

Schizophrenia is a continuing illness [ see 'burden of Care' ]

So, if part of next step is sufferer coming home, request a Carer Assessment by the Trust Team at the first 'needs' of sufferer assessment stage. This Carer assessment is where you will say is your need for support. if it is expected that you are to carry the burden of care

You will want the diagnosis - not 'psychosis' but 'is it schizophrenia?' - the working diagnosis that will be guiding the Team aftercare plan.[ one comment from a potential family carer... 'discharge to community care goes ahead regardless of whether you have the resources to care - or not ! ']

Care Programme Approach [CPA ]Guidance applies when the first contact is with a Trust Community mental health Team.

four parts to the CPA

Needs assessment - what the team decided will be needed for care after discharge,
Second ,the care plan to deliver what is needed.
a key person in the community team who will be responsible for carrying out the Care plan
fourthly the date for a review meeting of Care plan progress.

The first Team visitor is doing the first part of the CPA - a needs assessment.
They can just refer them back to the GP.

If no immediate urgency for a decision they will take their information and conclusions to the weekly Community Team meeting at which the Consultant psychiatrist and senior nurses will be present: the discussion and outcome will be minuted as should/will be any carer concerns as you have represented them.

If In-patient admission is to follow the Mental Health Act may be invoked in which case an Approved Mental Health Professional [ the old Approved Social Worker ] independent of the Team, will need to approve and accept the two medical Recommendations, will need to ask the Officially acceptable Nearest Relative - it may or may not be you - to agree or disagree with the Mental Health act admission, if the first admission, usually the 28 day Observation Order, they then go out and find a 'bed' .

The grounds for admission will be necessary for risk to sufferers health, and/ or a risk to others.

Don't think that if the professional Care has passed from the GP to the local Mental Health Trust Team that you should let the GP off his duty to the patient.
Make an appointment for yourself to see the GP and request that the GP keeps in touch with the continuing care.

If you are meeting concerns with Trust care, that you are not satisfied with the answers, make it the business of the GP to address the Community Team directly.
The patient remains the patient of the GP - even if they try to 'pass the buck' to the Trust community team.

An established grey beard psychiatrist once described professional and family carers as 'equal partners in care'.

An elderly fellow carer exclaimed
" equal partners my foot ! they see patients for ten minutes or so every now and again - we are caring for and about them continually all the days of their lives and ours !!!!!

and another
" they have all the authority overand submitted to by sufferer which they don't exercise - but little of the care ... we have little of the authority , and all of the care".

a frank carer experience In Inquiries after failures of care, one excusing comment often stands out - 'they were not ill enough as we saw them ',- they never asked the carers

The key to good care is to get carer observation and concern into the Team. Carer, always, should know when the team weekly meeting is and how to speak to a team member.

If a carer has doubts as to how any message will be received , it should be put in writing to the catchment area clinical lead consultant and if crtiical, witnessed.
If carer scepticism is serious, the letter should go to the Chief Executive of the Trust delivering the service. Most care failure is down to information not being given the concern and response that was necessary, sometimes by someone who received a message but did not let it go further. - weekly Community Team meeting

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