Can care integration cure ‘shitty life syndrome’?

The GPs around the table were expressing frustration about the increasing number of patients they were seeing who did not have medical problems. These patients, one GP said, were “suffering from shitty life syndrome”. This was not the type of language usually used in these formal meetings.

Voice of vexation

The GP explained he was referring to patients who came typically complaining they could not sleep and asking for sleeping tablets or antidepressants. A few questions about home life and it quickly became apparent that the husband had lost his job, there were mounting debt problems, their teenage daughter was staying out all night and their 13-year-old son with learning difficulties had recently been brought home by the police, accused with a group of other boys of criminal damage.

From the GPs’ point of view, the solution was simple – a social worker based in every GP surgery or at least offering weekly sessions. All eyes turned to me. I could have just said “well we would if we had the money” and there would have been a collective philosophical shrug of the shoulders and the meeting would have moved on with the GPs feeling better for the opportunity to voice their frustrations directly to senior management. But my role at the meeting was not to defend social services but to increase the shared understanding.

I didn’t start well. I explained: “It’s not a realistic solution as it would require a LA to double or even treble the number of social workers it employed.” Then I added: “It’s not the best use of scarce social work time to have social workers sitting in GP surgeries waiting for a GP to refer a patient when teams are struggling with unallocated cases and a backlog of assessments.”

To which the response was that this was not the best use of GPs’ time either. 

I agreed. I referred to the multidisciplinary community teams that after a difficult adjustment seemed to be one way forward, but had to concede that these were for services to older people so didn’t address the example raised. 

Major conundrums

At this point, another GP rep raised the difficulty of making referrals to the community mental health team, complaining they were focused on patients at risk of self-harm or suicide and not at all interested in what they considered low level mental health referrals.

This in turn led to another GP expressing her frustration in trying to get a service for several of her young patients from child and adolescents mental health services, which prompted another GP to ask why there was never anyone from children’s social services at these meetings. The chair stated they were repeatedly invited. All eyes again turned to our social service rep.

Now, in the world of local government, adult social services are in competition with children’s social services for funding, both claiming they should be offered a degree of protection from budget cuts. We don’t normally find ourselves defending the other.

However, I knew very well having discussed their non-attendance with the children’s services that they simply felt that having looked at past agendas this meeting was not the best use of senior management time.

Their priority was meeting with the police and other agencies directly involved in dealing with child abuse. Not surprisingly in view of recent child sexual abuse cases concerning older men grooming vulnerable young girls. Plus, I had heard rumours about a big investigation into historic abuse in the authorities foster care service. I reassured the meeting that, if there was a specific relevant agenda item, I felt sure my colleagues would send a rep.

Integrative solution

Whilst I still had the floor, I referred to the primary care trust chief executive’s recent attendance at a conference organised by the local authority as part of an attempt to coordinate strategies to address the problems of unemployment, poverty, juvenile crime, teenage pregnancy, and drug and alcohol abuse. If successful, this would ultimately impact on the number of people attending GP’s surgeries with “shitty life syndrome”.

The clinical commissioning group has replaced the PCT role but my experience of NHS and social care colleagues sitting down at the same table and trying to understand each other’s business seems even more relevant at a time when integrated care is meant to be a specific goal of the NHS.