Discharge 10. 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. We have done this and have not found any indications that something went seriously wrong.
11. Miss O told us she last saw her psychiatrist in March 2024 and was told she would see them again in three months, but this did not happen. She was discharged her in October 2024 after being under the service for two years. She says staff told her that her symptoms were more likely linked to her physical needs and she no longer met the threshold for a severe and enduring mental health difficulty.
12. The Trust had decided that Miss O did not have a ‘severe’ mental illness – this is defined by the Royal College of Psychiatrists (RCPSYCH) as:
‘Severe mental illness is a subset of mental illness and the term only applies to those with a diagnosable mental, behavioural, or emotional disorder that causes severe functional impairment that substantially interferes with, or limits, one or more major life activities. Conditions that could cause or be categorised as severe mental illness are generally considered to be psychoses such as schizophrenia, schizoaffective disorder, severe psychotic depression and bipolar disorder.’
13. As Miss O did not fit the criteria of having a severe mental illness our adviser indicated it was correct to discharge her at this time. Although we have seen nothing to suggest that the decision to discharge was inappropriate, we understand that having been promised therapy which was not provided must have been a disappointment for Miss O.
14. The Trust noted that Miss O had tried many different antidepressant medicines in the past which often had little positive impact on her and side effects have often caused her additional anxiety.
15. It said staff considered that psychological interventions may be helpful for her and the doctor arranged for her to be seen by the Assessment and Treatment Service (ATS) who could consider possible support.
16. The Trust added that Miss O was seen by members of the Psychological Therapy team who were able to assess her current needs. A clinical psychologist spoke to her about the support options they felt would be best placed to support her.
17. We can see ATS called Miss O in early October and Miss O said that she would no longer like to be offered a service by ATS. She said that she felt that the service was not for her and that she has found waiting for appointments and to hear back from people too difficult. She confirmed that she had contacted adult social care and was waiting to hear back from them.
18. She reported how she continued to feel angry and anxious, but that she did not want help from mental health services at this stage and that if she could access physical healthcare and housing support then this could improve things for her.
19. In early October the Trust had already decided to recommend community services to Miss O. She had previously tried medications and had not responded to them, she did not fulfil the criteria for having a severe mental illness, and she also had a lot of physical concerns which the Trust decided were likely causing a lot of her distress.
20. NICE guidance for ‘Service user experience in adult mental health’ says:
‘Anticipate that withdrawal and ending of treatments or services, and transition from one service to another, may evoke strong emotions and reactions in people using mental health services. Ensure that: • such changes, especially discharge, are discussed and planned carefully beforehand with the service user and are structured and phased • the care plan supports effective collaboration with social care and other care providers during endings and transitions, and includes details of how to access services in times of crisis.’
21. The Trust acted in line with this guidance when it discharged Miss O in October, it communicated the decision to her during the telephone call and told her about the options available to her. This was also followed up with a letter, a week later, recapping the discharge agreement and the options available to Miss O. This also included information on other services who could provide support to her and contact details for the Mental Health Line.
22. It appears the Trust discharged Miss O from its service correctly as it was determined that she did not reach the criteria for a severe mental illness, as explained by RCPSYCH, and it provided her with recommendations for services to access within the community. This, along with Miss O asking to be discharged herself formed the decision for her discharge. We have seen no indication the Trust did anything wrong here.
Communication New psychiatrist 23. Miss O says she spoke to her psychiatrist’s secretary who lied as they told her she would be assigned to another psychiatrist, however, it was not long after this that they discharged her.
24. The records show Miss O called the Trust in May 2024 to request a change of psychiatrist and an admin staff member actioned the request.
25. We asked the Trust for further details on whether staff actioned Miss O request. The Trust said in May 2024 when Miss O requested an appointment with a different psychiatrist she had already been booked in for an appointment with the psychiatrist she had previously seen for late June 2024.
26. The Trust said arranging to see an alternative doctor would have taken some time and relied on appointment availability within the service. It explained there was no identified clinical need for this to be an urgent appointment.
27. The Trust told us during the time Miss O was waiting for an appointment with a new psychiatrist, she was receiving psychological intervention and any clinical need for an urgent psychiatrist would have been raised. Furthermore, Miss O made the decision for her care to be transferred back to her GP in October 2024 before a further appointment became available.
28. Our adviser’s view on this, which we share, is that seeing a new psychiatrist at this point would not have altered the course of treatment or any of the decisions that were taken. We have seen nothing to indicate that the absence of a medical appointment with a psychiatrist had any negative consequences, because Miss O was assessed by an expert in psychology on 15 August.
29. We recognise if Miss O had received a new psychiatrist in this time, it could have changed her opinion about whether she wanted to be discharged, however, it does not change the overall clinical decision to discharge her.
30. We note that there are no specific relevant guidelines about requesting a new psychiatrist.
31. Our Principles of Good Administration state organisations must act in accordance with recognised quality standards, established good practice or both when delivering clinical care. Therefore, in this situation, we will use the professional judgement of our adviser which is based on established good practice.
32. We recognise it may have been disappointing for Miss O to not receive an appointment to see a new psychiatrist, in line with her wishes and before she was discharged. We note, however, that during this period she still had access and appointments with other clinical staff which did not highlight any need for an urgent psychiatric appointment.
33. In summary, we think the Trust acted in line with established good practice when it actioned Miss O’S request, although we recognise it must have been disappointing for her not to have another psychiatrist appointment before she was discharged.
Letter 34. Miss O wrote to the ATS Service Manager in August 2024 but told us she had no reply. She said it was only some months later that she was told by the Trust that the ATS Service Manager had passed the information to her new team.
35. The Trust apologised Miss O did not receive a response directly from the ATS Service Manager. It said the ATS Service Manager asked someone from the clinical team to respond to Miss O on their behalf. The Trust acknowledged the degree of vulnerability Miss O felt in sharing this information and apologised that the response did not meet her expectations and wishes.
36. There is no written response from the Trust to Miss O’s letter in the records. We can see she called the Trust in early October as she was upset about not having a response to her letter, someone then called her back the next day and again five days later from ATS psychology and discussed this.
37. We recognise the information within this letter was vulnerable for Miss O to share. We contacted the Trust to ask if Miss O’S letter was responded to. The Trust explained a member of the team spoke with Miss O at the time and responded to the concerns she raised but acknowledged this is not explicitly documented on her records.
38. As we have not seen any evidence of the Trust speaking to Miss O when it received her letter, we accept what she told us about not having any contact from the Trust about it until she chased this in October.
39. We understand it was disheartening for Miss O to not receive a response directly from the ATS Service Manager and that she had to chase this up after not receiving a response.
40. We think the Trust could have contacted Miss O in August to acknowledge her letter and tell her it had passed the information on to the clinical team. That way, she would have known what was happening and she might have been less anxious.
41. We note that Miss O was able to discuss her concerns with someone from the Trust in October and had already been given different support resources such as Sussex mental health line should she have needed it. We note, too, that in this context the Trust apologised to her at the time and acknowledged that Miss O’s experience could have been better, which we think provided her with an appropriate remedy for what happened.