The other night a tweet popped up in my timeline that made my heart hurt. I could feel the desperation, the annoyance, the helplessness in only 140 characters.
A person I follow shared that their family member was experiencing a psychotic episode but the psychiatric team responsible for their care could not see the family member til Friday. It was Monday. A range of emotions ran through me on that persons behalf but also my own as a clinician but then ultimately as a person of this country. The ‘lucky’ country. Really?
How is this symptomatic person lucky? They are feeling all alone, possibly paranoid, seeing people that may not be there, hearing voices or noises that are not present for the rest of us, feeling misunderstood with a high likelihood of having thoughts of self harm or harm to other people. How are they lucky? How are their family and carers lucky?
I don’t think they would be thinking they are lucky. What, lucky enough to get someone to come and assess by Friday when, if the team does turn up their mental state has deteriorated – rarely will a patient self-remit with their psychotic symptoms, in most cases the symptomatic person will have to be expressing a plan and significant intent for self harm or harm to others for the team to assess that they need to be admitted. On a Friday afternoon a bed must then be found – with the weekend looming the chances become limited. So, Psychiatric Services what does that mean? Oh that’s right the FAMILY have to take care of this person. Just like they have all week. Not for money, remuneration, or even pats on the back – rarely does this ever come. It is quite simply for love. But love doesn’t help when you have a psychotic brother, sister, mother, father or partner not trusting you have their best intentions at heart. Love isn’t the medicine that will stop the paranoia or the voices.
I was embarrassed as a clinician that this person and their family were being treated this way. I felt helpless that there was nothing that I could do. Even if I was still employed within the system I still wouldn’t have been able to do anything. I am a professional that has the skills behind me, I can only imagine what feelings this family were having.
Finally in this past election Mental Health was put on the agenda. It is fantastic that we have an advocate not only on the patients and the families behalf but also clinicians, Australian of the Year, Professor. Patrick McGorry. Let this be the start of revolutionary changes.
This incident touched me. I have written an open letter to our Prime Minister Ms. Julia Gillard.
Dear Prime Minister Gillard,
Firstly I am so pleased that you have been elected our nations leader. I truly believe that you were and are the right person for the job. I am though writing to you for a purpose.
Last night I was highlighted to the plight of a family having to deal with one of their family members experiencing a psychotic episode. Without knowing all the details and even if it were a case of assuming certain information the circumstances are unacceptable. The family were told that they had to wait 4 days for a service to make a face to face assessment of the person experiencing a psychotic episode. What were they to do with him in the meantime? Yes I am aware that families have management plans in place but when someone is acutely psychotic I do believe that the family should not have to be put under such stress when in this tenuous position.
I am aware that you can not do something clinically. Neither can I for that fact, although am qualified to do so. This is a service based issue. It is not state or region specific either – it is country wide. As I do not want to go over information that I am sure you have been provided with – statistics; what I will provide you with is a view from a clinician both providing a service but also seeing how a family is impacted upon by same.
I was lucky enough to be initially taught by some of the best in the business for family focused care and evidence based practices. The rural setting in country Victoria where my first training took place had a passionate and solution focused director and support managers.
I am aware that the recommendations that you have been provided with entail early prevention, youth focused strategies and projects for funding. I certainly do not disagree but what I do believe is that the patient and families like the one aforementioned feel they have continual support, irrelevant as to how long the patient has been symptomatic for or have been a part of mental health services.
I am aware policies and procedures are in place, I am aware that there is documentation and outcome measures completed and monitored but this goes deeper than that. It is about the human component. The one on one contact that needs to occur. Not just paperwork filled out and boxes ticked.
* Patients and Families need a face-face response when symptomatic within 24 hours (unless of course the family is happy with phone contact and a later appointment given.)
* Carer support needs to be given as a high priority. The more support the carer is given the decreased likelihood of feeling unable to cope when having to support the patient in an acute presentation.
* Increased access to hospitalisation (which I am aware is in your recommendations for more beds)
All of these have a flow on effect. If the patient is seen sooner then there is chance of less deterioration. If the carer is being supported the presenting symptoms are addressed earlier and again less deterioration in the patients mental state. If beds are available for admission the episode (more than likely) will be shorter therefore less long term disability and increased ability to return to normal functioning.
I loved working at the organization I mentioned for the 4 years that I did. I felt like I was making a difference with the treatment processes we had in place and the statistics reflected this. Unfortunately when I returned to the city and the suburbs there was no way I was going to be working in the public sector in Mental Health. The support structure was not in place and it is still limited in being able to provide effective treatment for patients and their families.
It’s not all about the statistics and outcome measures. It’s about the human factor – the love for the patients, specifically from their families and how best we can support them as a system and as a country.
After all we’re supposed to be the lucky country. At this point in time, the millions of Australians and their families affected by mental illness I am sure, are not feeling too lucky.
Please address the mental health system of Australia. It is in CRISIS.
I truly hope this family were able to get the crisis assistance they required. Thank you so much for sharing your family issue. Namaste`
It reminded me what I am passionate about and why I followed this career path in the first place. I have to trust that the changes that need to occur within the mental health system will for the benefit of millions of Australians. In the meantime I am here to keep reminding those to make it a priority!