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"Not Even Given A Chance"

About: Highbury Hospital Nottinghamshire Healthcare NHS Foundation Trust / Adult Mental Health Services - Community (City) Nottinghamshire Healthcare NHS Foundation Trust / Step 4 Psychotherapy Service

(as a service user),

I'm writing my "story" as I wanted to express my disbelief at the referral criteria/decison making of the Step 4 Psychology Service in Nottinghamshire.

A referral to a psychology service was first suggested to me by my psychiatrist in early 2016 following discharge from Highbury Hospital in late 2015.  I was discharged from Highbury on something of a cocktail of drugs - Risperidone, Citalopram and Clonazepam (I was discharged from there having been prescribed the equivalent of 30mg PER DAY).

Prior to my admission to Highbury, I also had issues with alcohol which were the result of long standing acute anxiety and depression from a very early age.

Since then I have worked with the local Adult Mental Health Services to manage my mental health issues and a local drug & alcohol service to drastically reduce, with the eventual aim of discontinuing my use of Diazeapam (I currently take just 2mg a day down from 30mg); I am no longer on Risperidone and I continue to work with the local alcohol & drug service to control my drinking to a safe level.

Recently, it was felt by the LMHT, my psychiatrist & my drug/alcohol support worker that I was now at the stage where I would benefit from (and probably needed) more long term support from a service such as Step 4 to be able to make any sort of sustained recovery.  The referral to Step 4 was also supported by my GP.

Hence a referral to this service was recently made.  To my utter disbelief, I have been refused access to this service and not even given the opportunity of an interview due to the level of drug use (prescribed benzodiazepines) and alcohol use.

I do wonder if staff in this service have any understanding at all of how challenging it is been to reduce Diazepam intake having been prescribed it very long term, at the same time as also controlling alcohol intake whilst also managing mental health issues.

This "decision" feels like a total slap in the face and to not even be offered the opportunity of even a brief interview I feel is atrocious.

I would be very interested to know if any of the other services involved in my care were even consulted before this decision was reached.


Response from Tom O'Reilly, Consultant Adult Psychotherapist & Step 4 Psychotherapy Lead, Adult Mental Health, Psychological Therapies

Dear 'aserviceuser'

Thank you for your post on Care Opinion. Hopefully, you will find the following response helpful to give you some understanding on why some referrals are declined by Step4 Psychotherapy. Unfortunately I can't respond specifically to your individual circumstances with your 'story' being anonymous.

When a referral is made to the Step4 Psychotherapy it is discussed at a weekly referral meeting by two senior clinicians in the service. As much information as possible is gathered so that an appropriate and timely clinical decision is made (taking into account the service requirements given to us by local commissioners). A decision is made based on the information we collect that includes the patient’s state of health on referral and whether it would be appropriate to accept a referral at that point in time. Any risks as well as any potential benefits of therapy are also given serious consideration; if there is a concern that therapy could increase the severity of the patient’s problems, which therapy can do, then the referral may not be accepted at that time.

If the decision is made not to accept a referral then a detailed letter is sent back to the referrer with a request that this decision should then be communicated to the patient. The content of that letter explains how the decision not to accept was reached. Advice, if appropriate is offered for other treatments that may help the patient or would be more appropriate at that point in time..

The referrer is invited to get in contact with Step 4 Psychotherapy if they want to discuss the decision or clarify any points made in the letter.

I hope this response helps you to have an understanding into how decisions are reached about referrals and that you are assured that no decision is taken without undue care.

We appreciate you sharing your feedback as it makes a difference when thinking about what we can improve on within our services


  • {{helpful}} {{helpful == 1 ? "person thinks" : "people think"}} this response is helpful