A hashtag and a new style of therapy

Greetings all,

Today I write about what I experienced on social media after the passing of cricketer, brother and son, Phillip Hughes, in such a sudden and unpredictable way. I experienced a world that is different to what we see on mainstream TV most nights, full of anger and hatred against fellow humans. It was an example of how desperately people who don’t even know each other, let alone ever met each other, feel compelled to reach out to those suffering.

I often get asked by patients why they feel so affected by something they see on TV or read about in the paper. This is an extremely common experience, one I remember that occurred when Princess Diana died. In a pre-hashtag era, people in the UK left thousands upon thousands of flowers at Kensington Palace. They were dumbstruck and it felt incredulous that somebody could be alive one second and not the next. Especially somebody so famous. They had to connect with others sorrow. Humans seem to be driven to find meaning even when there is none. After all, we know life is fragile, we can’t expect to live forever yet when it happens we cannot believe it to be so. That is grief.

I also explain to patients that humans are great ‘pattern matchers’, when they say they feel silly about being affected by something that happened to somebody they didn’t know. 

When we feel grief or sadness we may be taken back to a time in our life when we experienced profound loss. Hence the pain we feel is really a combination of what we are seeing and what we are remembering. Hence we may cry about a stranger’s passing, we may want to reach out and help in any way possible. 

I feel that devising the #putoutyourbats hashtag was an incredibly therapeutic gesture that will help not only to show the families suffering that people care, but also help people who are suffering to do something with their sadness.

As for me, and because shrinks have feelings too, II was deeply affected this week as I could relate to the first on scene doctors and paramedics. I have been in a few situations where I have offered emergency assistance with groups of people watching me, knowing how bad things are and desperately trying to change what really is fate. 

My worst experience happened in 2013 and I wrote about it here. Although I pulled a toddler out of a pool in a 5 star resort and did the sloppiest CPR ever seen that resulted in him surviving, I felt total guilt that was irrational and needed lots of ‘debriefing’ to manage. The way I was treated in the US was terrible but when I got home my colleagues were fabulous to my son and I, who also witnessed the whole thing. I wasn’t hailed a hero, I wasn’t even thanked by the family, but I don’t care because I know that little boy is alive now. Yet I still remember and I still feel uneasy when I see people performing CPR, and I still question to this day whether I could have done things differently.

I write this because doctors are lousy at admitting how affected they are (including me), and that they may need some support. I can only feel for Dr John Orchard who gave Phillip the best chance of surviving what was an incredibly severe injury. He did this with the players gathered around him, with the expectation he could ‘do something’ and he did it because that’s what us doctors just do. I truly hope he is OK and does seek comfort in the fact he tried his very best. Likewise the paramedics who did arrive early but have been criticised for an apparent delay.

And to the players and cricket community, I urge you to seek help weeks or months down the track if you need it. There is no such thing as a time when you should be ‘over it’. Only you can choose when it’s time to ‘move on’. You will all be affected in your own way. Find somebody to listen and help you. People are there if you ask, way after the hashtag goes away. 

My 'prize possession". My cricket bat autographed by Dean Jones in 1992.

#putoutyourbats

Dr Helen Schultz is a consultant psychiatrist at MindAdvocacy, Richmond, Victoria, and author of "How Shrinks Think" www.mindadvocacy.com.au

Common sense prevails

Greetings all,

Like many of my medical colleagues I am celebrating today with the news that the Federal Government’s GP co-payment system is all but defunct, despite incongruent press releases throughout the day. The co-payment system is thought to affect GP visits but many don't know it was desgned to involve radiology and pathology services as well. I don’t know how this has been overturned. I hope it was because common sense and benevolence won in the end. But regardless, I care because now there is a chance my vulnerable patients will still be able to access the treatment they deserve in a country such as Australia.

I wrote about the injustice of co-payments for those with severe mental illness on Croakey in June 2014, found here. My main point was that it was inhumane to impose fees for medications and diagnostic services on an involuntary patient who was being treated under the Mental Health Act, because of the fact that they were refusing treatment or unable to consent to treatment. I wrote it at a time too when I was working in a large city and struck by the amount of homelessness and poverty even in inner urban areas. I wanted to tell those who would listen that there must always be free health care for those most unlikely to advocate for themselves or pay for it.

As I wake to this news today I am working as a psychiatrist in a rural area servicing a large population and geographical area. Many patients are indigenous, many are also kept well by the public health system. As stretched as it is, staff are genuine and truly caring of their patients. I have been able to see how medications such as clozapine have actually turned the lives around of patients with severe mental illness, keeping them out of hospital for years. 

As I wrote earlier in the year, patients prescribed clozapine require weekly to monthly pathology tests to ensure they are not developing  life threatening side effects. They cannot pay for treatment and some are receiving treatment under the Mental Health Act, hence unable to consent to it. I know that if they had to pay $7.00 every week for 18 weeks for blood tests many would stop medications and become severely unwell, maybe even requiring months in hospital to recover. I suggest it best they receive outpatient care in an evidenced based manner rather than risk a relapse that would disrupt their lives or potentially place their lives at risk.

I was impressed to hear Dr Brian Owler, federal president of AMA, speak about the GP co-payment system today. I support his continued requests to work with the government on finding a better solution to funding care. I am not stating all patient should be bulk-billed. But I am very aware that to remove this advantage for everybody will leave an incalculable dent in the health care budget, notwithstanding poor patient outcomes and more strain for health care professionals that work in a stretched health system.

It’s Ok to make a mistake once, we all do. But if our current federal government doesn’t learn from this mistake by continuing to ignore key stakeholders such as the AMA and patient lobbying groups to my mind that would be reprehensible. 

Dr Helen Schultz is a consultant psychiatrist at 'MindAdvocacy' Richmond, Melbourne, Australia. She is the author of "How Shrinks Think" published November 2014.

Lots of talk but no action

Greetings all,

Many thanks to all of you who retweeted and replied to my blog post entitled “Not thinking before you speak”. It seems many are as outraged as I am about Mr Latham’s comments towards Lisa Pryor, and more importantly to The Financial Review for not retracting them.

As I have said, yes, all are entitled to freedom of speech but some acknowledgement that these comments are hurtful, stigmatising and lacking any credibility is still sorely missing.

The Royal Australian and New Zealand College of Psychiatrists have also replied to my post, stating via Twitter,

“Absolutely, Mark Latham’s comments are concerning and not helpful in removing stigma attached to mental illness.”

On this WhiteRibbon Day, I will keep up the fight to support Lisa Pryor, soon to be a medical colleague of mine, as well as advocate for public understanding and respect for my patients who ask for help and should not feel ashamed for receiving it. I will also continue to follow the campaign at Change.org and encourage others to do so as well. Over 1500 people have signed the petition so far.

Let's keep this going,

Best wishes,

Helen

Dr Helen Schultz is a consultant psychiatrist at MindAdvocacy in Richmond, Melbourne, Australia. She is a recent author of “How Shrinks Think” which can be purchased here.

Not thinking before you speak

Greetings all,

I begin this post by declaring that I know that in Australia we are fortunate to have the right to free speech. In particular, I am referring to Mr Mark Latham’s article published in The Financial Review last week which has caused an outrage amongst women who have mental illness or care about those who do. But what I struggle with is when those who speak from a position of influence don’t think before they speak. Or if they do and they are found to be incorrect, or indeed cause harm, don’t apologise.

I have no legal training and I am not a journalist, and don’t claim to know about tactics to sell papers or how a person is chosen to contribute to content. I am however a psychiatrist who can spend up to half her time in initial sessions with some patients reassuring them about what I can offer them and why it is a sensible and medically advised decision to seek help for mental illness. It is why I wrote my book “How Shrinks Think”. It’s where I see the most stigma. Behind closed doors, people suffering that I know we can help, but those that would be horrified if their friends or colleagues knew they were seeing a psychiatrist. Those I see get better, sometimes with medication, and still don’t want anybody to know they have a mental illness.

I can’t comprehend why Mr Latham would comment about mothers and mental illness, especially during BeyondBlue's post natal depression awareness week (16-22 November 2014). I do consider it necessary to set the record straight regarding depression and motherhood from a psychiatrist’s point of view.

If a woman is biologically predisposed to developing a mental illness they are more likely to have an episode at the time of hormonal fluctuations, i.e. during puberty, at the time of menopause, and guess what, while pregnant and after childbirth. Hence why the subspecialty of perinatal psychiatry exists. Hence the scrutiny for the emergence of post natal depression in biologically vulnerable people to protect the mother and in extreme cases the baby. See the logic there Mr Latham? The baby doesn’t force the mother onto antidepressants, the mother isn’t weak but the mother may be biologically predisposed to the development of depression, with episodes triggered by these hormonal fluctuations. Fantastic, capable, loving mothers who also have a personal or family history of depression. Thank goodness we do have effective treatments, dedicated mother‑ baby inpatient and outpatient services that care for both mother and baby while keeping them together to encourage bonding. 

Guess what else, Mr Latham, we know that we need to help the mother for the infant’s well-being as well. Something the child will not be blamed for, but the child may thank the mother for.

I have heard the notion that antidepressants are a band aid, a happy pill, something to become reliant upon or change people’s personality so many times it’s really not funny. No endocrinologist would cop the same when prescribing insulin to a 4 year old child who has type 1 diabetes. If a mother has depression she should not be made to feel ashamed if she needs to take antidepressants.

So I do concede Mr Latham has a right to freedom of speech but I would prefer it be informed and evidence based. I ask the Financial Review to accept utmost responsibility for publishing these remarks, pointed towards a successful and happy mother, by retracting the article. Remarks similar to those Mr Latham has made in the past regarding patients with mental illness. Then I can carry on working to debunk myths, educate and above all help my patients as my profession would want me to do.