vicswift

Non-engagement is often a symptom, not a choice. Over 15 years in the NHS, I saw a clear shift in how we respond to people who don't attend. When someone at risk missed appointments or didn't answer calls, we used to go to them. A home treatment or CMHT nurse would visit, check they were safe and try to bring them into treatment. As an on-call registrar, I assessed many people who had said they were suicidal but couldn't come to clinic or had missed appointments. The team was worried, so we made the effort to reach them many times during the night or at weekends. In recent years, I have seen people discharged despite high risk, simply because they don't engage. This is often based on an assumption that they have capacity, without a proper capacity assessment. The same happens to people with severe anxiety or agoraphobia. Some cannot leave home, yet they receive a letter, miss the appointment and are discharged without ever being seen. I have seen people deteriorate after this, in the NHS, in A&E and in private practice. We have moved from trying to engage people who are unwell to discharging them for not engaging, even when that is part of their illness. If someone can't come to us because of their illness, the answer shouldn't be a discharge letter.