What was the Issue?
Whilst in clinic or carrying out assessments, I have come across cases which have made me query our service and if we could do things differently, and if so how can we improve. I have a service user who was referred to service in contact with our service May 10 2019, it is documented they were seen by liaison psychiatry, notes indicated – Initial contact with Forward Think Birmingham (FTB) in 11/2016 complaining of low mood, lack of energy and struggling with course work. Service user was later seen again by FTB in 02/2019 and believes he has autism. However, reported they were diagnosed with depression and prescribed Mirtazapine. Following from that service user was referred to the Attention-deficit/hyperactivity disorder (ADHD) team for assessment, referral was done 24/5/2021.
Service user was first seen by me in June 2022, it was noted he did not complete his AQ50 test and therefore was given one to complete, test score came back as 34/50.
Referral was done to autism services in August 2022. At that time an automated email came up as:
We have now started processing Autism assessments again following a pause in the process as a result of the COVID-19 pandemic. There is still a backlog of approx. 12 months which we are working hard to address and as part of these ongoing efforts the CCG is working with an organisation called Healios for support.
What were the challenges?
Service user was first seen by the ADHD team September 21 2022 and then by the medic on January 23 2023, after being seen the below plan:
I believe it is likely that Pt. has autism and his difficulties can be explained by autism which is also supported by the fact that there is family history of autism. Features of inattention explained appear to be more in context of autism – scored 34/50 and is on waiting list for autism assessment. Has history of anxiety and is with CMHT with treatment and support from IPS. Is waiting for CBT . He mentioned that he has been referred for autism assessment and hasn’t heard anything yet. Has features of anxiety and depression as well.
What was the results?
Plan;
- CMHT to consider antidepressant duloxetine 30mg od for 2 weeks and then 60mg od to continue. Another option to try would be vortioxetine .
- CMHT to chase the referral for Autism .
- Pt to be discharged from ADHD services
What could have been done better/solution?
Looking at the above case study the service user has waited just under two years to be told by ADHD services he requires an autism assessment and is likely to have autism and does not have ADHD. If we had the appropriate service in place, we could have potentially been able to assess if able to do so, or signpost to help them understand their potential diagnosis.
