Nobody likes to think that they are not in control and not able to make decisions for their medical care. The thought can be extremely scary, and for many people they are petrified of what actually happens when you need to seek emergency medical care for a metal health crisis.
Personally, I had always had visions of the movie ‘Girl Interrupted’ with Angelina Jolie in my mind. It was set in a Psychiatric Hospital in the 1960’s with staff in white ready to tie her down and inject her with tranquillisers.
As I got older and actually became mentally unwell I had a real fear that if I admitted my true feelings then someone would take my children away from me. I never had the type of Post Natal Depression were I wanted to hurt the children, but I was still scared I would be misunderstood. So when you combine my fear of judgment, difficulty getting health professionals to understand how I was feeling, the fear I would be locked up and my kids taken, it is understandable that I was not keen to get help in the early days. Add to this the rumours you hear in small towns about what has happened to other people and well, what is a person to do?
When you talk about getting help for sufferers of metal health I have found there are 3 distinct categories. Some people experience them in order, some only one and some continually cycle through them all:
- Initial symptom diagnosis,management and control
- Emergency Treatment
- Recovery and management after crisis
I feel as a community we need to aim for all people to feel safe and supported in all three categories.
In Part 1 today I am going to focus just on :
Initial symptom diagnosis,management and control
In my local town we have just one General Practitioner. We are lucky to have him as many other country towns are losing theirs. However, as you can imagine sole doctors in regional towns have an enormous and unpredictable workload.
Currently you would probably be waiting two weeks to get into the doctor. So if you were after initial symptom diagnosis, management and control you would make an appointment.
Now this is where it gets tricky, what to do with you next?
Medication? Medication and some form of therapy? Therapy without medication? Your doctor will guide you on what they believe would work best for you. However, remember that it is your health and you or your support person have the right and need to speak up if you do not agree with what is being suggested.
Medication. There are numerous different types of medications to treat mental health conditions on the market. They fall into a few main categories and then there are the ‘common ones’ the ‘new to the market’ ones and the ones that were produced for a completely different condition to what you have, however some research has shown it may be worth trying anyway.
So you are prescribed the tablets, told they can take a few weeks to become effective and you go off to your pharmacy. Now I still remember the horror in Simon’s face the first time this happened to us. I was teary after the doctors appointment so waited in the car as he went in to the local pharmacy. As he returned back and sat down in the car he turned to me and repeated what the pharmacist had just told him. He needed to keep a close eye on me as initially some psychiatric medications can cause suicidal tendencies in some people for the first few weeks. Yes you read that correctly, going to get medication to improve your mood can in fact cause your mood to get substantially worse.
Also to be aware of is the time it can take for medication to work. The psychiatrists and doctors I was treated by as an inpatient last year stated that you really need to give a new medication 6-8 weeks before judging its effectiveness. Now that is an awfully long time to wait and have your symptoms potentially not improve or even deteriorate.
Depending on the skills of your local doctor and the severity of your condition you may need to see a psychiatrist, psychologist or councillor.
This will involve a further wait. Regionally I have found it extremely difficult to navigate these services. Over the Eyre Peninsula there are a few psychiatrists that visit some towns. I do not believe we have any permanently here. There is one that visits my local town, however due to personal reasons seeing him was not an option for me. I was not able to even get on a waiting list for anyone else outside of Adelaide (6 hrs away).
Psychologists, now I was unable to access an appointment with any outside of Adelaide in the private sector. I spent a lot of time going through the internet, ringing doctors surgeries in many surrounding towns and could either not get an appointment or laughed off at the thought of ever getting in. I could not get a straight answer, but it appeared these health professionals may not have been based in the country towns, but visit from Adelaide.
Through Country Health SA’s Mental Health Team, I went through a two hour intensive triage system to access services. The mental health nurser I was assigned to was extremely rude to Simon and I and did not think I qualified to use their services.
After trying and contacting someone else in their devision I was offered a telelink up to someone in Adelaide (none of these times was I informed of the persons qualifications). At this stage I was not looking after the kids, or myself, could not be left alone. Slept and cried all day and night when I was not heavily medicated, yet still I was not able to see somebody in person. I believe some people can have success with telelink ups, I personally could not do it. ( a telelink up is where you go into the local hospital in a room and via a large television speak to someone in another location).
Eventually, somehow ( I really can’t work out their system at all) I was informed I could see a councillor through Country Health SA who visited a town close to me. This would only be for 6 sessions.
Now as you can see the amount of hoops that you need to jump through to get services for mental health outside of Adelaide is soul crushing. As I am sure you can imagine this would be hard enough for someone without a mental illness, but when your mind is telling you to give up and that you are not worthy of being here, it feels like the universe is conspiring for you to fail.
At times over the years when I have been feeling good I have travelled to Adelaide to see my private psychiatrist and private psychologist. However, as you can imagine the time and cost is huge. Not only this, but what to do with children missing school to go with you.
Just recently I wanted to be proactive and got the ball rolling to see the local lady (that is all the information I could gain from our doctors practice or country health) that visits our town fortnightly. This took 2 months, 4 phone calls made by me, then 2 by Country Health to gain an appointment. Throughout the referral process I mentioned I would like someone I could talk to about my struggles and feel supported by. Now fast forward a few more weeks I arrive at the appointment to find a lovely lady, but she is a social worker. From what I could see a good social worker who could be extremely helpful to some people wanting to work on certain areas of their lives. However, this was not where I was on my journey and not what I had been verbalising as needing. Her skill set was not appropriate to the service I required.
So how does our community stand up to the task of diagnosis, management and control of someone with a mental health condition?
In my eyes there are many holes in the system.
- How can a person crying out for help be left without support?
- How can there be no clear pathways for referral to appropriate services from general practitioner to the next step?
- If staff levels are too low, then offer better packages to retain qualified practitioners in regional areas.
- Provide more training and mentoring to staff and provide it not only to doctors and nurses, but admin staff too.
- It is great that there are numbers to call in an emergency, however we need to work on the system so that people can get help before it comes to ringing LifeLine or similar.
It is much easier to do the preventative and early intervention steps in diagnosis, management and control of people suffering mental health conditions than to pick up the pieces when it all falls apart. Broken homes, drug and alcohol addictions, domestic violence and death are all very real possibilities.
In the next part in this series
Help when you need it most. How does it work in Regional SA? Part 2.
I will be discussing Emergency Treatment for a Mental Health Crisis.
Please contact me either publicly or privately with your questions or comments or personal experience. Together we can make change happen and I strongly believe change is needed.
Much love and peace,