I am not here today to make friends. I am not here to network nor to make good impressions in an effort to get work. Neither am I here to show boat! So, why am I here?
Locked wards? No, I talk about this subject a lot and nobody including Qld’s current health minister wants to even engage the subject.
Is it because, like prisoners we have our tobacco taken away from us and it is only returned on a persons discharge? No. No one seems to give a rats about that either. Or I simply hear a lot of nanny nation comments.
So like prisoners we are locked in without our privileges. This is for voluntary patients by the way not involuntary. Involuntary patients are treated the same they just acquire more paper work.
GUTS OF THE ISSUE
So let me reflect to you another uncomfortable truth.
A truth that, perhaps the public health sector particularly, may not wish to hear. People with severe and persistent psychiatric illness / disorders have no safe place within the public mental health system to go when acute or at risk. If you want confirmation of that outrageous statement join a lived experience forum. The scores of forum members I have come to know all tell a frighteningly similar tale and which inevitably ends with a person back at home still distressed, still at risk. Don’t ask staff with a lived experience, I already have and what they say is not the same as what those forum members are saying. Since being popular is probably not a viable outcome for me after this presentation, I would put forth the idea that perhaps actually being paid to work within a set model influences one’s critical capacity to be objective and informed about other peoples’ experiences within that model. Lived experience workers are a boon to the care of their peers but the model they are working within is incomplete and they remain totally unaware of this. As it stands with current modelling the therapeutic section of the model, which would count as the infrastructure is not actually there. For more than a decade I have heard the rallying cry of no hospitalisation! The rationale? Being in hospital, leads to institutionalisation. Bollocks! Very long term hospitalisation may lead to this but if you use the NGO support models in conjunction with a solid discharge plan, this is accounted for and the patient is supported through a transition from public health to the NGO sector. Pretty simple really!
So what do we have? We have a partial working therapeutic model. We have satellite services that provide day to day support for people managing a mental illness/disorder. This almost has the appearance of a help line model but with the social and therapeutic benefits only an ongoing interpersonal relationship and regular visits can provide. This is good. We have services whose sole purview is to connect clients/patients with the satellite services they require, be that mental health plan support, crisis support, access to general medicine and pharmaceutical support/ intervention, support and advocacy with other public departments. We have excellent new training for new workers who have a desire to add a positive influence into the lives of others by seeking their own recovery and in so doing support the facilitation of another’s. This is a fast growing workforce. And as such can support a true model.
A true model is not much different from current NGO modelling for service provision. It simply requires a real infrastructure. There is no public health infrastructure to base this model on. Without short – medium term hospitalisation (1 week to 12 months) there is a hole in the current model which not only means people are at the highest risk and suffering the symptoms of their illness alone. There is also a hole where properly trained and educated psyche nurses should be, (adding mental health to a nurses degree does not actually give them the knowledge or practice attributes required to be effective psyche nurses), because the goal of short to medium term hospitalisation is to stabilise and to begin and establish treatment for the patient, the person has more options to find and then maintain stability. And what do mentally ill people want more than gold?
Stability. Resilience then, is a backup tool not the primary coping mechanism.
It is a word which has so much meaning for so many people. Few others are even able to conceive of the benefits of this stability. Without that kind of care with that kind of outcome, all other service provision models are as a scent on the wind. They can have an enormous influence on a person’s recovery but without the whole model the satellites end up doing band aid work. This leads to service providers trying to provide services they are neither funded for nor are qualified to supply. As they are distracted by acute psychiatric issues, the longer term goals and outcomes recede further away and become pointless distractions, in and of themselves.
Let me begin with a telling of an event in the last year which has opened my eyes to the true nature of our Public Psychiatric Services system. I don’t often personalise when writing for professional readers or audiences. When I do it’s generally because I want to impart a message so strongly that actually making such a disclosure strengthens not only my resolve but hopefully also the message itself. So indulge me.
On the Monday the 7th of September, last year, I presented myself to the Prince Charles Hospital admission team. This had been organised by my private psychiatrist and the hospitals treating psychiatrist and the acute care team. It was agreed from the first words of conversation that I was a voluntary patient seeking admission to be weaned from a particularly inter-reactive and dangerous medication. As going into a locked ward troubles me, and brings back very painful and traumatic memories the idea was to make this a smooth and collaborative experience.
Within a few minutes the young registrar informed me of a new hospital policy that stated that all patients must hand over their cigarettes or other smoking materials. My response?
“You are fucking kidding, right?” In the same way you turn to a mate and say WTF? Incredulous and yet still seeing the humour.
And that is where things went off script in a major way. I looked at the door to see four extremely large and extremely intimidating security guards, a nurse from the acute care team walked in, told me that all conversation was now at an end I would be accompanying them to the ward. We entered the isolation cells and stood there for a count of 130. At this point I was then crowded into the PICU ward. Patient Isolation Care Unit. I tried explained to them that they had made a major error of judgement and that they should look to my file notes as to the nature of my admission. This was ignored. Obviously because I’m a nuttier!
A day and a half later, a doctor showed up. He is one of the senior doctors in charge of the unit.
He stated that the process by which I was admitted was hugely flawed that day, and that the assessment team had made some serious errors. I explained I had been completely miss-assessed, regarded as a threat and isolated all for no evidential reason. He agreed that I would be placed in an open ward ASAP, and that I would have double the smoking privileges. This felt to me like a cheap and tawdry bribe. I was asked to “keep it quiet, or the patients would riot”. After many hours I was relocated to west wing. I found out I was under an ITO only the day before it had run its course. So, to add insult to injury, not only had a voluntary patient been ITO’d but was not informed of it until its end. Now I was to begin the detox.
A so called treatment team suggested cold turkey at home was the best course rather than wean over a two week period in a safe place.
Just in reference to that point
My Doctor, Dr George Bruxner states that he never agreed to my discharge and was in fact outraged by the treatment I received from the acute care team. It was only later I considered the possibility that they simply wanted me off ward.
Tranylcypromine is a drug that takes two weeks minimum to withdraw from. It is a highly reactive compound and requires constant supervision as hypertension and tachycardia are major side effects of coming off the drug. Acute compulsive suicidality is also a major side effect of withdrawal. As I live alone and have no family, I was at grave risk. The withdrawal itself was physically harrowing and traumatic to deal with alone. It was never recommended by my own psychiatrist to detox this way and to be perfectly frank I was at dire risk the entire time.
The same three words kept going around and around in my head
NO SAFE PLACE TO GO!
I was desperately ill and the mental health unit which should be a sanctuary or to use a very loaded word, a place of asylum, was actually detrimental to my health.
And that’s when it struck me. There would probably never again be a safe public hospital system for psychiatric care again. Why? THERE IS NO SHORT TERM MONEY IN IT!!!!
As a younger person during the late 1980’s and early 90’s, I had accessed the same hospitals’ psyche unit. 6 open wards, one closed ward and admissions that ran for as long as was necessary for the wellbeing, safety and best treatment outcomes for the patient.
Yes there were issues, abuses, and systemic failures. But instead of salvaging the care and treatment portion of the hospital model the whole system was pulled down.
In its place we now have what amounts to little more than a triage unit that send it’s (frankly) doubtfully assessed Patients/CONSUMERS into the poorly integrated NGO models of mental health service for observation, care and treatment. Services that are not available in the NGO sector at any public level.
When speaking with people living with complex mental illness/disorders, the sense of hopelessness is palpable. With any complex diagnosis people require regular care from a clinician. What is provided by the state essentially covers twelve weeks of care and treatment with a clinician who may or may not even be knowledgeable about your particular disorder. Because of that fact, just on its own, people are suffering and people are in fact dying.
No Safe Place To Go!
Somehow, some way it’s been figured to be more cost effective to use the current half- model. And if it’s cheaper; then selling the idea to the sector is the last step. And they do this by calling, excitedly, for submissions of Expression of Interest into new modelling practices, for a better healthcare outcome no just for today for also for tomorrow.
What most people don’t seem to get is that “tomorrow”? is pretty close to literal. Short term economics has been the economic model since Bob Hawke’s last term as Prime Minister. In those days it was called economic rationalism. The rationalism lay seemingly exclusively within a 3-5 year period which coincidentally was also falls within the same time between elections. I don’t consider myself in any way a cynic, but it has been illustrated over and over by successive governments regardless of partisan politics; The ideologies of both major parties are as one in the practise of short stop economics.
What this says about the leadership in Australia is not for me to comment on here. But the practicalities are very simple. Twice in six months I needed a safe place to be assessed, observed, cared for. The simple fact is that a suicidal but voluntary patient was discharged by a system, so easily, and with no thought as to follow up care and then put that distressed person at extreme risk both medically and psychiatrically. That this is supposed a place of health and safety speaks volumes as to the disintegration of the entire public mental health system and to the lack of real commitment to Good Mental Health and suicide prevention. And the continuing isolation and mental distress, in many ways condemns the NGO sector’s ability to not only be effective advocates but more importantly illustrates the services required by people experiencing acute psychiatric distress cannot be met by the NGO mental health sector. They cannot provide a safe place. A 24 hr hotline is not a safe place. This is not only unreasonable to the extreme but is also terribly, terribly dangerous.
If you had kidney failure and were unable to receive the necessary treatment to survive, it would be considered unconscionable. People in mental distress are at the same mortal risk, so why the difference? I cannot answer that.
I do though have an idea for a pathway. At this point it is one man’s idea. A man’s idea who himself has little solid understanding of economics.
Now since so many psychiatrists claim to be frustrated with the current system and since too as a body they have a certain level of influence in regards to legislation and policy making, perhaps the Royal Australian and New Zealand College of Psychiatrists, The Australian Psychological Society along with the Australian Medical Association and even the Pharmacists Guild if they worked together, might actually help to facilitate real treatment modelling options. All have vested interests in better public psychiatric care. Alone each body has a certain political clout. Not overwhelming by any means but individually it’s there. Together with the NGO sector? It could be a big hammer.
Can you say the word COOPERATION? I have been lamented at by psychiatrists and psychologists for quite some time now about how impossible it is for them to actually practice their art and to help sick people feel better. They all complain, but it would appear, that is all they do. I am just a man with complex mental illness problems to do deal with; I simply can’t and won’t also carry the weight for the well paid professionals who are struggling. Boo Hoo! I must advocate for myself and I have no loaded dice but you guys? Well the only real impediment I see is apathy.
If you want to do your job well, take a stand. Take it in unity with your PEERS ! There are enough of you together to push the therapeutic point home.
Can you see the combined resources of just these four bodies? Just imagine this group with a political will to make mental health a state of being rather than a description of a service sector. I guarantee that if the political will is there, the NGO sector,( who are solely motivated to support people who experience psychiatric illness/ disorders), will march in step to help shape a proper paradigm of health.
Or are you too scared to even try? You have far, far less to lose than I do. Like so many others I could very well die because there is no safe place.
Imagine psychiatrists and psychologists if you look beyond your own short term economics and take on just two patients to bulk bill; the benefit for those who are in need of weekly or fortnightly appointments ( even if it’s simple maintenance) will be immeasurable. You will also being doing a thing. Taking an action which is truly morally good. I know that most of you actually care about your fellow humans. You chose your field of endeavour based upon that care and the desire to at the very least ease pain. Take “Cause No Harm” to its logical end and bring comfort where for so many for so long there has been none. Me, I’ve forgotten how to hope. Do you even care?
But hey just say it can’t be done and it won’t be.
And we will just continue to undergo the lived experience of having a mental illness as we have it this very day. That’s the choice, folks. It’s really that simple.
As for the economic benefits the basics are easy. With a healthier population you have increased work engagement and productivity. With greater economic independence comes a higher level of consumer spending which in turn adds to the nation’s GDP. To go just a tad deeper, with increased productivity leading to greater profits, national and international investment is encouraged.
This is of course based on long term economics. And therein lies the rub.
Us against them? This is a negative starting point. We must convince those who need convincing of the worth of providing real and meaningful psychiatric care for its own sake.
Either way mentally ill people are suffering greatly for no other reason than economic ones. This is in a first world economy, by the way.
I would like to pose a question. What is a government is elected to do? It is elected to provide essential services for its citizens and to oversee the making and application of law, policy and build on past strengths to make a greater and more prosperous nation going on into the future.
Since when, did health and education become nonessential services? We are a first world economy. We are wearing Big Boy pants. It’s time to act like it.
Look, I am not pretending to have the answers; I don’t Do economics. I’m not even pretending I know what all the questions are. But we do have experts in economics, legislation and policy and the attendant procedures regarding all these things.
We come back and the word is still cooperation.
The word is cooperation.
But hey just say it can’t be done and it won’t be.
And we will just continue to undergo the desperate lived experience of having a mental illness as we have it to this very day.
It is only through uniting and pooling our resources and knowledge and drive that we can affect change. If we don’t, at best the suffering will continue, and not only will people continue to die but it will happen more often. If it happens often enough (and we know this through our prison models, and we know through homelessness modelling), people just stop giving a goddamn. That’s the people. The public, they’ll just stop giving a damn. This apathy has been modelled throughout Europe, The U.S. and Great Britain. And if we can succeed in this then surely we can succeed in working with these other disadvantaged and endangered people. Just because people are poor doesn’t mean they stop having worth. I’m poor. I live in poverty. What am I worth?
I am complexly mentally ill. My disorder is extreme in its treatment resistance. Do I matter?
If I matter, doesn’t everyone else?