Throughout my time in IAPT in Lancashire (I had 2 separate occasions working there) I was employed as a PWP and was taken on to “get the waiting list down” in terms of the volume of cases which had been referred, predominantly by GPs. I am an Agency Nurse who has worked in many roles across the country, but this was my first role as a PWP. The first thing that occurred to me was how little awareness the PWPs had about mental health and how people were allocated to various parts of the Service. There seemed to be an emphasis on “clearing the lists” because lengthy lists would not be favourably looked upon by the commissioners and may affect the funding already provided for the Service, but also future funding.
My PWP colleagues were very new in practice and many of them had only recently qualified and as I have previously outlined, they had little or no experience around mental health. I was initially asked to “look after them”, since it was very common when working over the telephone to find a suicidal patient on the other end and have a colleague not know what to do. I was often asked to sit in the room with my colleague and to support through the assessment, as I was in a position to know when to call an ambulance or to get further assistance, where often they did not. Many patients who were referred to IAPT services, especially at step 2, were referred wholly inappropriately. My colleagues were subjected to a degree of unnecessary distress and pressure by these inappropriate referrals, as they knew that they were inappropriate, but were expected to treat them in any case. In cases of face to face referrals, the situation was often worse, since inexperienced colleagues very often were asked to give 6 or 8 sessions to someone who had been referred who was actively psychotic, but whom the PWP did not recognise as being psychotic. The result of this at best, was that the patient never got better and at worst, may have harmed either themselves or another person. There were also safety issues in terms of lone working in buildings which were vacated at 5 pm but in which it was expected that workers would have to receive patients because the Service was open until 7 pm.
Anonymity protected – Dr Mike Scott