Birmingham and Solihull Mental Health NHS Foundation Trust

4. Mr R complains the Trust incorrectly rejected his referrals to its CMHT between August 2023 and February 2024. He says he has had no mental health support from the CMHT, which he says has caused him to feel anxious and depressed. He says he is hearing voices and has not been sleeping properly. He says he does not understand why it will not provide him with support. Mr R wants an acknowledgement of failings.

5. Mr R is a gentleman with a history of type 2 diabetes and asthma. He also has a history of mental health issues and has been referred to the Trust several times in the past.

6. On 25 August 2023 Mr R’s GP wrote to the Trust to request support for him from its CMHT which is a specialist secondary care NHS service in the community rather than a primary care service coordinated by a GP. The Trust reviewed his referral on 28 August and said he did not meet its criteria for secondary mental health support. It referred him to its ADHD services instead as he had described issues with this in the referral.

7. In September his GP referred him to the Trust to assess him for suspected borderline personality disorder. The Trust declined the referral, as it said he did not meet the criteria for further input from the CMHT for his symptoms.

8. On 1 November the Trust wrote to Mr R’s GP to confirm its reasons for not considering him for further specialised secondary care input. It noted it had been advised the courts had carried out a psychological assessment and it requested a copy of the report if his GP thought it was appropriate. His GP sent on the report to the Trust.

9. The Trust assessed Mr R on 21 December considering the report. It wrote to his GP on 17 January 2024 to confirm he did not meet its criteria for CMHT support. It confirmed it had referred him to its Neighbourhood Mental Health Team (NMHT) to support him with another course of cognitive behavioural therapy (CBT). CBT is a talking therapy that can help someone manage their problems by changing the way they think and behave.

10. On 30 January Mr R attended the Trust’s ED as he said he was hearing voices. The Trust’s psychiatry liaison team assessed him and recommended he engage with the NMHT. It advised him to contact the crisis number if he had any further concerns. The NMHT discharged him from its service on 6 February as he did not want to engage in CBT.

13. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen.

14. Mr R says the Trust incorrectly rejected his referrals to its CMHT between August 2023 and February 2024. He says it did not provide him with any assessments or support which has stopped him from sleeping. He also says he hears voices and is anxious and depressed, which we were sorry to hear about. From what he has told us it is clear Mr R has been through a distressing time.

15. The Trust’s framework on referral criteria to its CMHT says the CMHT will provide assessment and specialist support, care and treatment for people with: • severe and persistent mental disorders associated with significant disability, predominantly psychoses such as schizophrenia and bipolar disorder with complex needs • any serious mental health disorder where there is on-going significant risk of harm to self or others or where the level of support required exceeds that which primary care could offer • serious mental health disorders requiring complex psychological intervention or intensive psychotherapy treatments.

16. It goes on to say individuals may also be referred to specialist services which includes the Trust’s services for ADHD if this is an issue.

17. Mr R’s records show he was referred to the Trust’s CMHT in August, September and November 2023. We can see his GP originally referred him in August following a request from Mr R for support with anxiety, depression and ADHD from CMHT to help him to move forward and have contact with his children. The Trust reviewed the referral and noted there was no evidence which indicated he needed support from the CMHT. It also noted his GP’s request for support with ADHD symptoms and referred him to its ADHD service. Which appears to in line with the Trust’s framework above.

18. We can see his GP sent a further referral on 28 September asking for a second opinion from another CMHT. On 1 November the Trust noted that it had discussed Mr R’s request with a clinical director, and they agreed that his presentation did not indicate a need for CMHT support. The Trust wrote to Mr R’s GP to confirm this. It also advised it could consider further evidence from a court led psychology assessment his GP had referenced in his referral.

19. Mr R’s GP sent the assessment report to the Trust on 14 November, and it assessed him 21 December. We can see it carried out a full assessment in which Mr R discussed his frustrations around not seeing his children and the trauma he faced when his father sadly died. The Trust explained to Mr R that it may decide that lower levels of support may be more appropriate for him. It contacted him in January 2024 to confirm that it was referring him to its NMHT to help him with CBT techniques and there was no further role for its CMHT as this time.

20. It is understandable Mr R is concerned the Trust missed opportunities to support him, as it clear from what he has told us that he continued to experience symptoms and did not understand a clear reason why it could not support him.

21. Our clinical advisor explains based on the medical records there is no indication that Mr R should have been seen by the Trust’s CMHT during this period because his problems at that time were related to social, justice, benefits and anger issues which would not be supported through a CMHT.

22. Based on the evidence we have seen it appears the Trust followed its framework when it rejected Mr R’s referrals and requests for support from the CMHT.

23. We can see the Trust considered Mr R’s reason for his referrals to its CMHT service. It rejected the referrals as there was no evidence to indicate he was experiencing symptoms associated with a persistent serious or severe mental health condition which required complex support or treatment from a CMHT.

24. We can also see the Trust assessed Mr R each time based on the information he and his GP provided, including a court led assessment. When it realised, he did not meet the criteria for the CMHT service he wanted, it referred him to other departments to support him with what he was experiencing.

25. It is clear from what Mr R has told us, he feels rejected by the Trust and does not feel like he has been supported by it. We do not wish to underestimate how difficult it must have been to relive these events and explain his complaint to us. We are grateful for the time and effort he has taken to do this.

26. Overall, based on the evidence we have seen, we are satisfied the Trust did not get anything wrong and followed guidance when it considered Mr R’s referrals between August 2023 and February 2024. We will therefore not take further action on this complaint.

27. Understandably from what Mr R has told us his experience has caused him great distress and we are sorry to hear about this. We hope this statement clearly explains our decision not to consider his complaint further and gives him some reassurance the Trust has taken his complaint seriously.

1. We have carefully considered Mr R’s complaint about Birmingham and Solihull Mental Health NHS Foundation Trust (the Trust). We are sorry to hear about the events that led to Mr R’s complaint. Understandably, he feels the Trust incorrectly declined his referrals as he went on to experience anxiety and depression without this support.

2. We have looked at the evidence Mr R and the Trust gave us. We were sorry to hear he thinks the Trust incorrectly rejected his referrals it its community mental health team (CMHT). It appears the Trust followed its guidance, and we did not see any evidence something went wrong with the way the Trust reviewed his referrals. Although Mr R thinks he needs support from the CMHT, it appears he does not meet the criteria in place for this service.

3. Therefore, we will not be taking further action on this complaint. We will explain our decision in more detail below. We hope the information in our statement gives Mr R some reassurances about what happened and explains why the Trust did not do anything wrong.