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Mental Health The UK's unfair rules on Benzos for Mental Health patients!

ageingpartyfiend said:
Today I heard about someone actually getting a (to be decided - ritalin or dex though) script for adult adhd from a GP. The person did have a previous dignoisis but it was an 'educational diagnosis' as opposed to a clinical one. A psychiatrist was mentioned but I can't recall the context - perhaps it had to be approved but, if so, must have been deemed a formality)

Outliers are that the GP has extensive mental health / SpLD training (rare as hens teeth), the patient is eloquent and does not come over as a drug-seeker whatsoever (they aren't)
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This actually is very interesting because the guidelines on ADHD diagnosis are pretty strict. This might seem to contradict my previous comment but it doesn't. The TL;DR version is: the diagnosis is tricky to get due to a combination of limited NHS resources (hence so many people going private) and a load of red tape, but once you have the diagnosis getting stims is a piece of piss in the vast majority of cases.

But a GP starting a script based on a childhood informal diagnosis? This is very odd. Under normal circumstances, even a regular psychiatrist cannot make an ADHD diagnosis, they must be an ADHD specialist. Adult ADHD is also considered a separate condition from childhood ADHD in the UK (for reasons I will never understand) so a childhood diagnosis doesn't mean much of anything as an adult. You have to start from square one again regardless.

If I had to guess at the details of that situation, an ADHD specialist psychiatrist wrote a referral to the GP formalising the diagnosis, and as the GP in this case has mental health training they both feel comfortable setting out the medication regimen. The diagnosis is the bit they tend to worry about, as they don't want to overdiagnose the condition and give out stims to people who don't actually need them. If they're confident in correct diagnosis there's usually no problems.

There may be some type of approval process depending on the CCG, this is mostly a formality however it's still a drawn out bureaucratic one. When my mate got his dex script transferred over to the NHS they took months going through this process before he finally got it on the NHS. Whereas when I got my script transferred I literally just showed my GP the private script and got an equivalent NHS one there and then.

However I have a longstanding relationship with that GP and my mate didn't with his, so that could make a big difference. Also we both got diagnosed privately, so the same process may very well not apply when the referral is from an NHS specialist.

Finally it might be an important detail here that once someone has an ADHD dx and is on meds, a GP is allowed to manage the script. They can move patients to different stims, increase doses, etc. No rules stop them from doing this, it comes down to just how comfortable do they feel doing it. A lot of GPs will refer someone back to a specialist for this simply because they don't know anything about ADHD and are aware the meds are controlled drugs. But they can just as easily do it themselves if they want to.
 
Wilson Wilson said:
This actually is very interesting because the guidelines on ADHD diagnosis are pretty strict. This might seem to contradict my previous comment but it doesn't. The TL;DR version is: the diagnosis is tricky to get due to a combination of limited NHS resources (hence so many people going private) and a load of red tape, but once you have the diagnosis getting stims is a piece of piss in the vast majority of cases.

But a GP starting a script based on a childhood informal diagnosis? This is very odd. Under normal circumstances, even a regular psychiatrist cannot make an ADHD diagnosis, they must be an ADHD specialist. Adult ADHD is also considered a separate condition from childhood ADHD in the UK (for reasons I will never understand) so a childhood diagnosis doesn't mean much of anything as an adult. You have to start from square one again regardless.

If I had to guess at the details of that situation, an ADHD specialist psychiatrist wrote a referral to the GP formalising the diagnosis, and as the GP in this case has mental health training they both feel comfortable setting out the medication regimen. The diagnosis is the bit they tend to worry about, as they don't want to overdiagnose the condition and give out stims to people who don't actually need them. If they're confident in correct diagnosis there's usually no problems.

There may be some type of approval process depending on the CCG, this is mostly a formality however it's still a drawn out bureaucratic one. When my mate got his dex script transferred over to the NHS they took months going through this process before he finally got it on the NHS. Whereas when I got my script transferred I literally just showed my GP the private script and got an equivalent NHS one there and then.

However I have a longstanding relationship with that GP and my mate didn't with his, so that could make a big difference. Also we both got diagnosed privately, so the same process may very well not apply when the referral is from an NHS specialist.

Finally it might be an important detail here that once someone has an ADHD dx and is on meds, a GP is allowed to manage the script. They can move patients to different stims, increase doses, etc. No rules stop them from doing this, it comes down to just how comfortable do they feel doing it. A lot of GPs will refer someone back to a specialist for this simply because they don't know anything about ADHD and are aware the meds are controlled drugs. But they can just as easily do it themselves if they want to.
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Nope.

The person with ADHD had been diagnosed for the first time around age 30 by the trained SpLD assessors at her Uni.

She provided a copy of her diagnostic assessment to her new GP, alongside a self-written description of her experience of the symptoms. The GP then interviewed her over Skype and set the wheels in motion for a script. There has been mention of a psychiatrist but I'm not certain of the context, but I suspect is merely to back-up the GP, hmmm unsure but will report back should I hear more about the situation.
 
That is very unusual.

I literally just presented my gp with a report from an educational psychologist from the spld team at uni that diagnosed me as ADHD and I was told I had to go to the ADHD clinic and it was 18 month wait just to get an appointment.
 
Yeah very unusual. The psychiatrist definitely needs to be involved in that situation for anything to happen and they need to be a specialist too. Otherwise that GP could get struck off for just scripting stims to someone who hasn't been diagnosed with ADHD by a specialist.

I'm guessing there's some details we're missing.
 
Wilson Wilson said:
Yeah very unusual. The psychiatrist definitely needs to be involved in that situation for anything to happen and they need to be a specialist too. Otherwise that GP could get struck off for just scripting stims to someone who hasn't been diagnosed with ADHD by a specialist.

I'm guessing there's some details we're missing.
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Yup tis very unusual which is why I commented. I'll be able to find out more in a few days so situation will become clearer. Some detail definitely missing as already said. Person is definitely telling the truth though.

Edit - One thing - diagnosis was done by a specialist. I mean all SpLD assessors are qualified specialists but this one was previously employed as some kind of consultant in/for nhs etc. I would imagine the diagnosis would still be classified as 'educational' though given the setting of the tests (a Higher Education establishment)

The GP will be getting busy once word gets out they are competent in mental health
 
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ageingpartyfiend said:
Yup tis very unusual which is why I commented. I'll be able to find out more in a few days so situation will become clearer. Some detail definitely missing as already said. Person is definitely telling the truth though.

The GP will be getting busy once word gets out they are competent in mental health
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Yeah not doubting you at all mate just trying to speculate on an unusual situation, very curious to hear the details.
 
I was actually shocked when I wok up to these things about a decade ago. I was considering switching from methadone to morphine mst time release becaue of the shorter half life making detox easier. It took about 30 minutes on the phone finding someone who could offer that high dose ongoing morphine script and I'm sure that would have been just the start of it, all you had to do was go and piss dirty once.
 
Interested to see how things got on with the OP psych app? Hope everyone is doing alright and coping well!
 
I was recently assessed by my local NHS psych team and as part of the medication discussions I asked them if I could have a very small amount of temazepam each month, maybe just 100-150mg or so. The psychiatrist I spoke to was actually very much not anti-benzos in the way most uk docs I've ever spoken to are, they were absolutely happy to recommend my GP script a small amount like that each month as essentially there's no risk of dependence at that level. That's still rare though, and when I mentioned I felt more modern GABAergic drugs were often just as dangerous but less effective she agreed completely.

Anyway she agreed to recommend me for 150mg a month, but it's the GP that has to prescribe everything so I went to him today and of course he can't find the recommendation. He was actually just going to write out what I told him to until he realised one of them was a controlled medication but his negligence is something of a tangent, in the end I had to let him go and make some calls and wait for them to contact me. Of course they don't contact me and when I call them back he's just written out the scripts we talked about, but the temazepam is for 280mg (10mg nightly for four weeks). The anti-depressant is on repeat but the temazepam isn't because it's a controlled drug, however I have absolutely no doubt that when I make the next appointment they'll just repeat that monthly meaning I'm getting double what was discussed. Still a fairly low amount but definitely not what they should be doing if that DOES happen.

Anyway, it's jellies and ice cream for tea tonight for me so i'm not complaining.
 
Generally, the z-drugs offer a lot less of a chance of tolerance to the sedative effects as opposed to classic benzos. That's from a pretty high authority, too.
 
Yeah I would agree that as a sweeping statement it's not 100% correct.

The new generation IS an improvement over the old generation in some ways, but not necessarily the ways in which they were touted. Definitely less effective at some jobs though and they have their own set of issues.
 
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