surgery guidelines and mental health

[Sunshine100]

Hi all,

I attended an appointment with a friend today who is looking to have bariatric surgery. She asked me to come along as I have been through the process and might better understand what was being said than her.

I was shocked by what I heard. The nurse taking my friends health history stated that NICE guidelines state that if a person has had involvement of professionals for mental health support (in this case a CPN) within the two years previous to referral for bariatric surgery they would be refused funding for surgery. You must be two years clear of any professional help.

This to me seems strange for a number of reasons. There must be many of us who have depression and the likes (which is what my friend has support for, she is stable and has been for a while but still sees her CPN once a month) Does this rule mean that people with ongoing mental health conditions such as psychosis for example who require support will never be entitled to NHS help?

I have read through the NICE guidelines tonight and can not find anything about this. The closest I can find in there is that they must address any psychological issue that could affect relationships with after surgery prior to referral to the surgery list.

Has anyone here been refused funding because of having mental health support ?

I am not sure what to make of it all

 

[_Victoria_]

Its a real shame that thats the case 'cause like you say, a lot of the times your weight can lead to your depression but at the same time i suppose they have to make sure that people are mentally stable to deal with the roller coaster of emotions that come along with the surgery. I've seen so many people on here saying how much they have struggled emotionally after surgery and find it hard to come to terms with their new selves.. i cant imagine how tough it is but its got to be even tougher for someone that already struggles with a mental illness.. seems like a lose lose which is really sad for your friend hopefully she can work something out so she can get a win!

 

[beepbeepcat]

Upset for your friend and How odd, I totally understand that they need to see mentally if you can cope with rapid changes in your body and lifestyle. However a bit of my story ..... As part of my run up to being agreed to tier four surgery they supplied a cognitive therapist for them to judge if I'm ready to cope with it. I cried at every visit, had been on anti depressants on and off over the past five years and defiantly within two years, off work with desperation and only had 3-4 hours sleep a night due to various reasons. Now why can't the team assess this case properly on an individual basis as mine was. They were in contact with my Dr so had access to all my medical records, I'm very disappointed and upset for your friend. Sorry to ask what's a cpn.?

 

[los in it]

have to say this is a first for me

 

[Kar8858]

Bariatrics are evolving all the time and new data may change the guidelines. They have a duty of care after all and maybe new data is showing a correlation with mental health and the surgery success and failure along with further issues.

 

[Sunshine100]

Hi everyone,

Thanks for responding.

I am still feeling confused by this. I totally get that they need to assess that surgery is the correct way forward for each patient. Including assessment of their ability to cope mentally. Having had surgery myself, I know how difficult it can be.

However, to dismiss someone with no further information about their mental health other than they have issues with depression and have support for that from a CPN (community psychiatric nurse) seems unfair to me.

It seems such a shame if this is true. I feel for people with ongoing mental health conditions if it is true. ?

 

[sundown]

Well I'm rather more cynical - I'd say that it sounds far more like a health region that is trying to distort sensible NICE guidelines into an excuse to refuse funding and save budget.

If your friend does get refused she can always appeal the decision on the basis of poor interpretation of NICE guidelines. Nobody has to accept what their health authority tells them first time around - become a squeaky wheel who doesn't go away and uses up a lot of their administrative time and money and in the end the cost/benefit scale swings in your favour.

 

[potter]

Hi there Sunshine

This definitely sounds like creative interpretation of the rules. The intention of the NICE guidance is to urge caution for people whose mental health problems may lead to issues with dealing with the surgery and its aftermath, they specifically mention diagnoses such as schizophrenia and drug or alcohol addiction. This shouldn't mean people with psychosis will never be able to have surgery, just that the psychosis should be well enough controlled that surgery won't lead to deterioration in their condition.

I have suffered with depression for many years and regularly use mental health services including psychology and psychiatry. I had a gastric bypass funded by the NHS (in Stoke on Trent) in September this year. During the assessment the only issue was assuring that my mental health team agreed that I was prepared for the surgery and I was well enough to handle it emotionally and they would be able to help me through any blips afterwards (they did agree and have been very supportive!)

The nurse who advised you that your friend was not eligible for surgery due to mental health issues was incorrect, and well done to you for picking this up and supporting your friend. As well as being post-gastric bypass I also work in NHS public health and the spreading of incorrect information such as that given to your friend really annoys me but is sadly typical of the attitude of some people towards those who suffer with mental health problems.

Good luck, Potter x

 

[nicnakmac]

I attended my seminar on Wednesday. I wasn't told anything like that and my dr's know my diagnosis of bipolar and still wrote off to the bariatric team. According to guidelines from what I've read is that it's uncontrolled mental health that gets knocked back. My cpn said that he will be writing a supporting letter for my surgery saying that a lot of my issues have been linked to my weight and that I am stable motivated and take my medication regularly. He said that will stand for a lot of they look for.

 

[Sunshine100]

Thanks everyone.
After taking a little more time to think about the appointment in its entirety, I am sure they do not have enough information about my friends mental health to form an appropriate decision.

If they decide to turn her away I will be looking to help her appeal the decision. There is no way they can make a fair assessment from simply knowing she has had issues with depression and has a CPN.

Thanks again for all of your input

 

[purplemel75]

Hi, I've not been on here for a while as I've had a lot going on at home.
I'm currently going through the assessment process for my surgery now and as someone who suffers with both bipolar disorder and depression I will admit to being worried about these affecting my chances of having the operation.

However, last week I saw the psychologist as part of the process and she couldn't have been any more helpful. We talked for over an hour and a half, put the world to rights etc and basically quashed all my worries about it affecting my chances as she thinks I'm doing really well, and that I'm well informed about the op and all it entails. She said she had no problems with recommending that I go through to the next stage and I now have my next appointment with the Dietician for later in the month.

I asked if she would be willing to support me through the process and she said she would be happy to see me as often as necessary as I know I will need support with dealing with my emotional eating side of things, even though this has greatly improved since starting the process as I've been doing a meal replacement plan for the past 6 months and have since lost 4 stone.

I hope your friend can find a way to change this decision as it seems very unfair to be penalised for being depressed. Surely they must appreciate that our situation with being so overweight just compounds our depression? Well, it certainly does with mine anyway.

Best of luck, and I'm sure she realises how lucky she is to have such a supportive friend xx