Locum Shmocum

Most people will agree that continuity of care is a good thing (the exception to this comes if you don’t like the care you’re being given, but I’ll leave that be for now). The ideal is that you are referred to a psychiatrist, you get to know them (and they get to know you), you even build up a trust in their opinions and (again, ideally) there comes a day when you are referred back to your GP (feeling much better). It might take six months or it might take 20 years (or more), but that’s what everyone (in theory) is after – recovery and a ‘normal’ life. This world being far from ideal, and the mental health system being far from ok, this just doesn’t happen.

Why? One of the biggest spanners in the works is that the likelihood of having the same psychiatrist for the duration of your care is pretty slim. Ok, this wouldn’t be too bad if we were talking about 30 years or so – but when it’s a matter of months or a few years then something is very wrong. I’m lucky, in the 4 years I’ve been under my local mental health services I have only had two consultant psychiatrists. I saw the second as a result of ‘sacking’ the first, so I have no complaints there. Now, though, my shrink has moved on to pastures new and I’m in the nasty position of having absolutely no idea where my next one is coming from.

I have entered The Locum Zone.

Here in The Locum Zone continuity of care is a dirty word. Here you can be admitted under one psychiatrist and, two weeks later, discharged by another (the previous one having found a tastier position, perhaps). Here you tell your life story to one amiable shrink, repeat it to another (who seems not that interested) at your next appointment, repeat it again to someone new (who seems very interested) and then have to go over it all again to someone new (by which time you are understandably fed up with it all and are perceived as ‘resistant’ and ‘aggressive’). I can repeat my psychiatric history backwards, standing on my head whilst juggling flaming torches with my feet (well almost – you get the point though, don’t you?). In a 15 minute appointment (I’m being generous here) there isn’t much time to do anything else.

Some locums are fantastic, they have an easy manner and really seem to care about their job, but this does about as much good as a holey umbrella if they’re not there the next time. The enthusiastic ones might try to get to the heart of your difficulties and decide on a treatment plan only for it to fall by the wayside 3 months later when the next one comes a calling. This can be just as bad as the ones that just go through the motions, as you begin to believe that you are finally getting some decent help. The whole effect is destabilising – which, unsurprisingly, is not a good thing for your mental health. Trust is one of the central, maybe even the central, factors in a therapeutic alliance. How can you trust your psychiatrist if you don’t know who they are? Tough one, that.

The answer? Err … More psychiatrists would be a start, but as there’s a massive national shortage of these I’m guessing that’s not going to happen any time soon as things stand. Maybe we need to ‘think outside the box’ (to quote an overused, and frankly annoying, buzz word). How about opening up the discipline of psychiatry a little? Perhaps it’s time to make ‘treatment’ teams multi-disciplinary in the true sense of the word. As a patient I don’t really care if my care is headed by a shrink, psychologist, occupational therapist, specialist nurse or random person off the street PROVIDING they know what they’re doing. As long as I get on with them, respect their opinion and know that they intend to work with me for more than 2 months I’m up for it. It’s got to be better than the current situation.

So then, it’s pretty clear that the Locum Zone is not a good place to set up store. Why don’t we find somewhere else that works a little better, and maybe then we can get on with this business of getting our lives back!

Rachel Waddingham © 2003