Thursday 7th January 1993 Morning coffee break 11:50

“There are two gentlemen to see you, Dr Lewis.” Andrea ushered them into the staff room. “Gary Grant from the Child and Adolescent Metal Health Service and Paul Knowles from the Community Mental Health Team.”
“Good morning, Dr Lewis. We’ve come to discuss one of your referrals.”
Dr Lewis looked puzzled. “One of my referrals! I’m surprised you’ve got time.”
“Well, we haven’t,” said Gary, “but it’s a tricky one. We thought it would be better to talk to you in person.”
“It’s that patient you referred to us 3 weeks ago, Simon Rowley,” Paul explained. “He sounds like a troubled young man.”
“Yes, he is. I’ve been very concerned about him.” Dr Lewis said.
“It seems as if he is in a deep depression.” Paul continued. “Of course, it is to be commended that you have been seeing him every two weeks, Dr Lewis. Thankfully, you have been able to do so.”
“Like I said, I have been very concerned about him.”
“Well, those frequent thoughts of self-harm he’s been having are quite alarming. It is a relief that he has only cut himself twice and superficially, at that.” Paul took a deep breath as he said this. “We hope that the burns on his arms may have been accidental.”
“I don’t . . . “
“You have also pointed that he does not really have any established support network,” Gary interrupted quickly. “His social circumstances are chaotic to say the least. We haven’t even got the reassurance of a cohesive family unit. Like you, we are both extremely worried about him.”
“Although we are extremely worried,” Paul stated matter-of-factly, “he does not quite meet our urgent assessment criteria.”
“Nor ours,” said Gary.
“I thought he might not,” said Dr Lewis. She shook her head.
“It means that we would have to see him routinely,” said Paul. “Neither of us can offer anything in between routine and urgent. We cannot see him ‘fairly soon’ as you requested. Those sort of appointments don’t exist.”
“Now, this throws up a conundrum.” Gary said. “We suspect that you are already aware of it which is why you referred him to both of us. Simon had his 17th birthday at the end of last month. At the moment, in the Child and Adolescent Mental Health Service, our routine waiting list is 12 months. By the time we are able see him, he will have just turned 18. Unfortunately, we cannot assess or treat patients who are over 18 years old. The regulations are very strict. As an adult, he would need to be seen by the Community Mental Health Service.”
“That’s where I come in,” said Paul. “The good news is that our waiting list is not as long. At the moment, it is only 9 months. In fact, I could offer Simon an appointment on 9th September next year but he will still only be 17. In the adult mental health service, we cannot assess or treat patients who are under 18 years old. These are irritating regulations but they are important.”
“You can see our predicament, Dr Lewis?”
Dr Lewis frowned.
“For Simon,” Gary continued, “it was a bad time to become ill.”
“I have got a bit more good news regarding our adult service,” Paul continued. “We have managed to recruit two new community psychiatric nurses. They are joining us in 3 months, on the 5th of April. We estimate that, once they start, our routine waiting list will be reduced to 6 months.” Paul looked at Dr Lewis and smiled.
“Sadly, that won’t help Simon,” Gary said.
“Of course not,” Paul nodded. “But it is good news. I am also going to have to ask you to re-refer him to us in June, Dr Lewis. It is against our policies to ‘hold’ referrals in case anything happens, if you know what I mean.” He winked and took the referral letter out of his briefcase and handed it to Dr Lewis.
“We did hope there would be some sort of compromise,” said Gary. “That’s one reason why we thought it would be helpful for both of us to come today. Whilst we were waiting for you to finish surgery, we went over the whole situation in detail. I think we have explored every avenue but I’m afraid there isn’t anything we can do. There does not seem to be a solution.”
“I am sorry to say that there is no flexibility in the system,” said Paul.

For Simon, it was a bad time to become ill.