Antidepressants

The GP is usually the first point of contact for people seeking help with depression and other mental health problems and will normally provide ongoing support. However, where problems are more complicated the GP may refer people to a Community Mental Health Team (CMHT) for more specialist help. Some specialist teams accept referrals directly from families, social workers or voluntary groups.
 
The CMHT includes a number of workers with specialist knowledge and skills such as a mental health worker, psychiatrist, Community Psychiatric Nurse (CPN), social worker, occupational therapist, clinical psychologist and outreach worker. There are different types of mental health teams that operate in out-patient clinics, hospitals, day centres, and team members may also visit people at home. There are separate teams who work with children and adolescents, and the elderly.
 
When someone is referred, they will be assessed and the team will decide who will work with each individual. People are usually allocated a ‘key worker’ who coordinates their treatment.
 
‘Home Treatment’ or ‘Crisis Resolution’ are teams that are available 24 hours a day for help in an emergency. They aim to treat people in the least restricted way and as close to home as possible.
 
CMHTs should work closely with the GP as both are involved in prescribing medicines. If a psychiatrist recommends or starts a prescription the GP must be informed so that he or she can issue prescriptions in usual way and be aware of all the medicines a person is taking to keep the medical records up to date. Usually any changes or alterations to the medicines will be decided by the psychiatrist but the GP still issues the prescription. Some CPNs are able to prescribe certain medicines. (See ‘Antidepressants: The Psychiatrist’ and ‘Antidepressant use and hospital care’).
 
It was clear from our interviews that there were variations in the way care was organised by CMHT’s in different health trusts. People told us they had seen CMHTs for treatment in hospital, at out-patients clinics, or in their own homes. Usually they had been referred because of severe or recurrent problems and the GP felt they needed specialist help. Rachel felt that being looked after ‘in the community’ was preferable to being admitted to hospital. Collette found it helpful to speak to different health professionals who had experience with mental health issues, and knew about the different medicines and their effects.

Sometimes people are referred to the CMHT because the GP has concerns about their safety, or contact can be started in a crisis or an emergency such as an overdose, or being ‘sectioned’ under the Mental Health Act. (See ‘‘Antidepressant use and hospital care’).
Rachel has a long history of depressive episodes and has taken antidepressants at different times in her life. There have been several occasions when her care has been transferred to CMHT. ‘I thought I was going to kill myself so I had emergency care and I was with the crisis team’. Hannah was referred to the crisis team on several occasions because she had taken an overdose. She was admitted to hospital, and when she returned home they visited her. 
People who were felt to be at risk of harming themselves were sometimes visited at home by their keyworker, in some instances daily, to give them their medicines, If the team were concerned that the person might take an overdose this was safer than allowing them a supply of their own at home.
 
Dina not want to continue with the medicines she had been prescribed and felt she was being coerced by the CMHT ‘they said I had to take it physically in front of them because I mean I didn’t want to take my medication… basically the only thing that they were doing were to bring the drugs and insist that I take the drugs’. Although often people knew why they were being closely monitored, it could feel like an imposition. Others found that home visits gave them opportunities to talk to someone about how they were feeling or about the treatment, and get expert advice. Rachel found it difficult to leave the house, so home visits were helpful.
 
Sonia said her mental health team had ‘an open door policy’ which meant that she could return to see them when she felt she needed to, without having to get a new referral from her GP. Rachel was worried that she might not be able to access the CMHT once she had been discharged and that she would have to go through the referral process again if she needed further help. Flora thought mental health teams should work more preventatively, rather than waiting for a crisis. Several people were aware of a lack of continuity and ‘joined up thinking’ between the members of the mental health teams, the GP, and other therapists or counsellors they were seeing. Thomas felt frustrated that his GP, psychiatrist and psychologist seemed to have conflicting agendas ‘my psychologist... never focused on medication... He would see it as the psychiatrist job or the GP’s job. The GP and psychiatrist would see medicine as their job but not the talking therapies. So it was a complete non communication between the people that I was seeing’.
 
Janet felt let down when she was transferred to the elderly care team ‘it’s just hopeless you never see the same person’. Sonia sees a private therapist and found it was difficult being under the care of different health professionals. ‘They (CMHT) don’t like the fact that they have no awareness of what he’s [therapist] doing with me… equally he feels very frustrated because he feels that they’re stopping him from doing the work that he wants to do... he doesn’t agree with the medication I’m on… they want me to have therapy with them rather than him.’ But Sonia preferred to see the private therapist because she had built a relationship with the person, and it was easier to fit appointments around her job. 


Last reviewed June 2016.
​Last updated June 2016.