(43) Depression
The Truth about Depression BBC Full Documentary 2013
Leaving hospital
What happens when I leave hospital?
Following discharge from inpatient care, a letter is sent to your doctor detailing what treatment and medication you have had, and the follow-up arrangements made, e.g. date of the next outpatient appointment. Arrange to see your doctor in the week following your discharge, for a review. You will also need to get a new prescription for your tablets. You are usually given a week’s supply of medicine from the hospital. It is worth taking the medication with you to the surgery to show your doctor - sometimes a hospital letter is delayed. An awful lot of tablets are white - the exact names and dosages will be needed.
Day care may be suggested - this may be anything from a morning a week at the hospital to 5 days per week depending on need. Day hospitals offer a wide range of treatment from group and individual work, to creativity sessions and anxiety management courses. A wide range of health professionals are involved in providing treatment in a day hospital.
When you are well enough, treatment will be completed in the outpatient department - a visit to the clinic at lengthening intervals, until your care is then transferred back to your doctor. Fares to and from the day hospital or outpatient clinic might be refundable - do ask.
A CPN (Community Psychiatric Nurse) may visit you at home. What does a CPN do?
CPNs review your progress, monitor treatment and sometimes do specific tasks, perhaps helping you gain confidence leaving the house. They may visit you if you have recently come out of hospital, or give regular medication to someone who has longer term difficulties, such as a psychotic illness. CPNs may have a wide range of skills, and often have a variety of roles. Some will be ‘nurse therapists’, expert in providingtreatments, such as cognitive behaviour therapy, relaxation training, or basic counselling. They may also have responsibility as ‘case managers’, coordinating community care (medications, benefits, day hospital, drop-in centres), enabling people with more severe illness to manage at home.
What is a care plan?
My granny is in hospital and I’ve been invited to attend a case conference about her. Every patient who is admitted to hospital will have a multidisciplinary care plan made to meet overall medical and social needs. A key worker is appointed to coordinate care, and to seethe plan through. For example, someone might need housing improvements, home help, meals on wheels, and a supply of regular medication.
Doctors, social workers, family, psychiatrists, and nursing staff may all be involved in planning someone’s care before they leave hospital, to see that every aspect of their case has been considered. Family may be asked to attend, as relatives’ opinions and concerns are very important.
Having time off and getting back to work
If you are unwell with depression, it is important to know when to switch off from work for a while, as your work performance is significantly affected even if you don’t quite realise it. We describe the basic paperwork - medical certificates, or sicknotes - that you will need if you become unable to work for a short or longer time. We explain how to get help with benefits, and the allowances that are available for people with longer term illness and their carers: Statutory Sick Pay, Incapacity Benefit, Disability Living Allowance, Community Care Grants, Crisis Loans, and Invalid Care Allowances. We also mention where you can get skilled help to find your way through the complexities of the Benefits system.
After a spell of depression, it is often wise to get back into work gradually: the Therapeutic Earnings Scheme, as well as an Occupational Health Department can both be of help here. It is not always easy to know what to say to people at work, and we discuss who to tell.
Sickleave and sicknotes
How do sicknotes work?
For a short break of up to 1 week, you’re entitled to self-certify. Your workplace will have a supply of self-certification forms (SC2). If you need longer than a week, your doctor will give you something called a Med 3. This states your illness (perhaps in vague terms as we’ve mentioned elsewhere) and how long you’re likely to be off sick. This can be a Final Note if you’re going back within 2 weeks, or an Open Note if it may be longer. This can be as long as 6 or even 12 months for long-term illnesses. My employer asked me for a private sicknote when I was off sick for a few days.
My doctor says I have to pay for this. Can they do this?
Yes they can. You are entitled to submit an SC2 (self-certificate) for short spells of illness (less than 1 week) but your employer may wish for more details from your doctor. This seems to happen more often when people have had a lot of sickleave. Some of us suspect that this is used as a disincentive to taking more time off work, or to make life uncomfortable for employees by discouraging sickleave. Private Sicknotes cost around £10. I missed some time off work last summer and now my employers want a backdated sicknote.
Can I get one?
A sicknote cannot be backdated as it is a legal document, and today’s date is today’s date. To get round this, your doctor can issue something called a Med 5, to state that you were indeed ill in the past. This can be done if, say, there is a recent hospital report about your case, or from doctor records of your past attendances. This can be useful if you have moved, been in hospital, or changed doctors. Gaps between certificates can be covered in this way, if you overlooked getting consecutive sicknotes, or if (and this is not unknown) the Department of Social Security (DSS) have lostone of your certificates.
What is a Med 4?
This completes the set of sicknotes we’ve described. People who have been off sick for some time must be considered for an All-Work Test, to see whether they are fit for any work, not just their usual job. The DSS may ask you for a Med 4. This gives them some more information about your state of health, and may enable them to confirm that you are entitled to longer term benefits without having to have an independent medical examination by a DSS doctor. This is usually a routine request after you have been off sick for some time.
I missed a Court attendance last week and I understand I’m in trouble. Can I be excused on medical grounds?
Try never to miss Court cases, whether as a witness or a defendant. The Bench tends to take rather a dim view of excuses. Some people with a depressive illness may become genuinely overwhelmed by being involved in Court proceedings. However, you must take action before the proposed Court appearance. Talk to your solicitor about this, and ask them to write to your doctor requesting a medical report. They will need your written consent for this and there is likely to be a fee. If your doctor has been treating you, he or she may be able to help, if aware of yourcondition, and if you would genuinely have been unable to attend Court because of it. Retrospective sicknotes are often rather difficult to do, from the doctors point of view, with the best will in the world. Make sure your doctor and solicitor know with good warning, that you have difficulty in attending court.
Does your doctor have to write depression on a sicknote?
I don’t want people at work to know about my problems. Sadly, depressive illness is still seen by many as stigmatising. The situation is slowly improving and more and more firms – and certainly the bigger ones – will be concerned about every aspect of their employees’ health, as they do have responsibilities towards your working conditions nowadays. Occupational Health Departments of the bigger firms will have a brief to improve stressful situations in the workplace, if this is a problem. If they are aware that an employee is under pressure, they may be able to alter things in the workplace to make life easier. So, whilst in general it is best to tell the truth, there are certain cases when it is best to use less stigmatising terms. Doctors will be only too aware of this issue, and are often quite prepared to write something vague and non-specific like ‘Stress reaction’ or ‘Nervous debility’ on sicknotes when necessary.
