Why I am against fad diets and measuring your self worth by the number on your scales

Today I spoke on 3AW with Dr Sally Cockburn about my concerns re fad diets and unhealthy messages not endorsed by experts.

As a doctor who sees many patients with eating disorders I become very concerned when fads appear that promise weight loss.

As a doctor, I am also aware about the health risks that can be caused by obesity. Of course I encourage and support healthy eating and exercise to be the body shape we are designed to be.

What I am NOT happy about are un-endorsed promotions for sale such as the 12WBT that promote weight loss and incorporate misleading information such as the importance of counting calories and regular weighing. Patients with eating disorders such as anorexia nervosa and bulimia nervosa perform these behaviours at an obsessional level. Encouraging people to weigh themselves and then to apportion their self worth to a number is dangerous and can lead to the onset and relapse of eating disorders.

Programs such as the 12WBT have not been endorsed by any regulatory health body, or have published any data about whether rapid weight loss by consuming a very low calorie diet leads to long term change. What we do know is that eating a balanced diet, watching portion size, reading labels on food packaging, and engaging in moderate regular exercise is the way to sustain the weight you should be for life. It is also the way that you can make a huge difference to many preventable diseases such as hypertension, diabetes and arthritis.

I have met quite a number of people who have enrolled in the 12WBT program with all the best intentions only to discover that the very low caloric intake in the first few weeks in unsustainable. Not because they are weak, or greedy or lack discipline, but because they are not consuming enough nutrients to sustain their daily activities.  This can then be interpreted as being a failure, and further reduce self esteem. Listening to hunger cues and eating when hungry is a normal human behaviour. Realising you are hungry and depriving yourself of food as a form of strength is pathological. And, there is no one magic number of calories that all humans must adhere to, but there are guidelines about a healthy range.

I tell my patients that they are the special unique people they are because of many factors. not one is what number they are on the scales. And I know that for many people with eating disorders, this message takes years to sink in.

By all means be healthy, happy and exercise for your physical and mental health. Just read the fine print and if you think something is too good to be true, well it probably is.

Stay well over Christmas and New Year,

Helen

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

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. 

Finishing my book then having a good lie down – on the couch

Greetings all,

Well, I am very happy to say I wrote the final words of my new book “How Shrinks Think” yesterday (editors changes pending). The last word I wrote was ‘psychiatry’. The last topic I wrote about was psychiatry and social media. Who would have thought that this Facebook avoidee and Twitter ignorant person a year ago would now be embracing this great means of global communication!

It is timely for me to reflect on this change in my learning and outlook. That’s because I don’t think I would have ever finished my book (editors changes pending) if I didn’t receive all the help, support, encouragement and opportunity I have been fortunate to experience in the Twitterverse this year.

Some of my friends and colleagues in my life know I have been writing a book since August 2013. Many don’t. It does feel embarrassing I suppose to announce where ever you go that you will be an author someday. So, in the main I didn’t. But on the rare occasion that I did, people seemed generally interested. They were interested to know what I had written about and incredulous that I could be relatively easy in this era of self-publishing. But largely, I have written the book just for me. I don’t know how it’s going to be received, but regardless, I will continue to remember that.

In all sorts of ways the interrelationship between my experiences on social media and my writing journey have been closer than I would have imagined. I began to ‘play’ with the concept of writing about modern day psychiatry from the ‘inside’ on January 1 2014. I started my blog “How Shrinks Think” to sort out my own thoughts as well as gauge others impressions of what I had to say. I was scary at first but then a whole lot of fun. Then I gained the courage to use my voice as blogger and writer of “How Shrinks Think” in order to enter the world of campaign building. I was very involved in @AHPRAaction in May, and then wrote about the federal government proposed Medicare Co-payment and the effect it would have on those with severe mental illness. This propelled me into re-connecting with colleagues from the past, particularly from my AMA days, including Mukesh Haikerwal, and Amit Vohra. Opportunities arose from this including the privilege of being a speaker at the inaugural AMA(Vic) DiT conference.

I also discovered the talent and experience other doctors in Australia had when it came to writing. Although we have never met face to face, I consider Edwin Kruys in Queensland and Jacquie Garton-Smith in Western Australia to have really inspired me to keep writing and ultimately ending the journey that is the first draft of a book. I was fortunate enough to have some blog posts picked up by Croakey, and managed to connect with psychiatrists in Australia and around the world.

It is no coincidence that I will launch my book at @SoMebythesea on November 15^th 2014. I am organising this workshop amongst incredible people, many  I would never have met were it not for Twitter. It is amazing that virtually all of the organisation and promotion for @SoMebythesea has occurred via the amazing network opportunities of social media. Now I have Dionne Kasian-Lew, Marie Bismark, Mary Freer and Jen Morris coming along to speak at @Somebythesea. All people I have met via networking.

Of course, I have not forgotten my friends from the beginning and pre SoMe. Some are also growing and expanding their social media presence, like the sleep guru David Cunnington. Brad Mckay has been a great mate all along and a wonderful mentor for me in this new foray. My journey did begin with Andrew Griffiths and Kylie Bartlett, and I will always be grateful for their teachings and guidance. And all my friends who have been there, offering advice and encouragement.

So, the next 6 weeks are now in the hands of my editor, Roy Mazucco, and designer, Carly Goodwin. Incredible to believe but if all goes to plan, I will have my book in my hand in 6 weeks. May need to see a psychiatrist to process it all.  

Shrinks and Social Media

I don’t ever remember learning about social media at medical school back in the '90s. Social media was reading the newspaper or a magazine before uni started. In the olden days, merely 20 years ago, we had no idea the www was coming.  Dr Google was somewhere in the lecture theatre but we didn’t recognise him/her, and we couldn’t imagine that there would be communal platforms like Facebook around to unite strangers and label them friends.

Lecturers teaching ethics in medicine did not fathom a world where doctors would live within social media, and have to work their way through the twists and turns of setting up and maintaining Facebook personal pages, doing their best not to be found on social media by their patients, yet really wanting to share photos of recent holidays, and remain in touch with colleagues.They certainly wouldn't have envisaged doctors embracing socila media as an effective means of building communities, promoting evidenced based helath messages and influencing for change. 

Regulatory bodies such as AHPRA and professional associations such as the AMA have tried to keep up with the growing trends of what was considered a fad and considered absolutely not relevant to professionals, certainly doctors, but then had to begrudgingly accepted social media as something here to stay. Unfortunately the regulatory bodies, not the medical profession have advocated for the way social media should be used in medicine, and many doctors remain unaware that they need to know more about social media in medicine.

More and more, doctors want to influence debates on health matters, and nowhere is this more real than in psychiatry and mental illness. In 2014 we must realise that stigma is rife and campaigns such as ’@RUOKday’ and days dedicated to suicide prevention are popular because there still exists a fundamental belief that to be depressed is weak and something to suffer in silence. Large NGO’s with stacks of cash  have departments that run social media campaigns, driving their messages home, influencing the debate and keeping the radar on the topics. But what about doctors? Why do we believe others can pledge our plights and we can be taken as read, without being read, that we support or refute an argument or counterargument without making our own unique and collective point of view known? How do doctors, particularly psychiatrsts feel about campaigns such as @RUOKday, and what are they saying about it?

In Australia, the ABC is running a campaign called 'Mental As' to coinicide with national Mental Health week in October 2014. Great to use high profile celebrities to 'raise awareness', but what does a psychiatrist feel about a campaign being labelled "Mental As?" How do psychiatrists feel about raising awareness for a most valuable area of health, yet with limited funding to provide care when patients seek help?  How do psychiatrists feel about being labelled as those that treat 'mental patients, a most derogatory and stigma enhancing term. Isn't that where psychiatrists can have a say? In summary, advocacy about mental illness on social media is one sided, lacking a robust evidence base and not informed and influenced by experts in the field - psychiatrists themselves.

In the last 5 years it is pleasing to see medical colleges such as RANZCP and RACGP join social media, tweet regularly and highlight very important policy decisions they are making regarding such critical issues as the mental health issues facing asylum seekers and offshore detainees. In recent times we have seen doctors unite over issues they are passionate about such as #AHPRAaction, #ScrapTheCap and #CoPayNoWay. Because the fact is this. Social media is not for posting what you ate for lunch or where you spent your holidays. Social media is for connecting, uniting and advocating as a mass of people from so many walks of life that would never have been able to come together so quickly in any other way. Campaigns on social media work quickly, they pack a punch and they influence.

I write as a novice to social media, coming on board in January 2014 as a naysayer and critic. It was because I didn’t know about this side of social media. I learnt from other professional bodies, dipped my toes in the twitter universe and discovered to my amazement there were people I could find and follow who felt like me. People who admired what I did and followed me back. I quickly joined an amazing campaign called #AHPRAaction and stood up to our regulatory body to defend our rights in the context of social media. Four months after I opened my twitter account. Now I blog regularly, have a company Facebook page, tidied up my LinkedIn profile, set up a psychiatrist’s and registrars group on Linkedin (PARA) which is gaining membership, and have almost finished my first book.

And what about me as a doctor, passionate about psychiatry, and with my experience as a writer and learning the ropes about being a shrink? Well, now I have a voice and a brand. I have stepped forward and claimed my identity that is authentic to me, before others can post about who they think I am. I have bought my domain name www.drhelenschultz.com, and claimed the @Drhelenschultz  twitter handle before somebody else does and pretends to be me. Not a narcissistic thing to do, but a sensible thing to do, as the real estate space in social media gets clogged, people find new ways to influence and may wrongly do so by purporting to be somebody else. And because I want to guarantee my future both in the business and medical world as well as the social media world. The two are intertwined. I love the feeling that I can write what I think and own it, and others can truly decide whether they admire me or not because they know the real me.

As for psychiatry, I will continue to have a presence and a voice on social media, finish my book “How Shrinks Think” and be a thought leader when it comes to our treatment of those with mental illness, and what we can all do better. I’ll stand aside NGO’s and colleges as somebody who works within the system and has a right to have a say. That say will be shouted on social. 


Dr Helen Schultz is a consultant psychiatrist based in Melbourne, Australia. She is also founder of CPD Formulations, a medical education company that creates medical education programs written for doctors by doctors. Her new workshop is called @SoMebythesea, to be held on 15th November 2014, in Torquay, Victoria. It will be the inaugural social media workshop for the medical profession. 

Feeling connected

Doctors are extremely busy people. So are many professionals. We go about our day attending to our patients, reduce our ever increasing pile of administration, run our practices and juggle our personal lives. When our patients need us in an emergency they have no idea there may be quite a few with similar needs on the same day. And nor should they. We are quite skilled at triaging, attending to the problems at hand and delivering as much as needed for our patients. But there does come a time when we would like to raise the white flag and say, STOP! Just for a minute, so we have a chance to breathe and an opportunity to recharge.

I have taken myself away for a weekend of solitude and reflection, a moment to take stock and assess where I currently am in my career and where I am heading. Giving my all, as doctors do, can lead to needs to escape and energise. And so here I am in a coastal location, remembering who I am and what is important to me. 

This is no new revelation. Doctor’s mental health and wellbeing relies on the notion that we all need a break, we all need to listen to our bodies and minds, and pro-actively manage our needs for our own health and the health of the patients we are responsible for. So, why do we find it hard to get away?

Part of it is the realisation that at the end of the day, many of us are small business owners, managing staff, and scrutinising cash flow. We are not only responsible for our patients but also for our staff and our obligations under tax law. We work to pay our college fees, medical indemnity and other professional liabilities we incur as doctors. We juggle our time amongst our clinical duties and our business requirements. We can, quite easily, forget that we are like other doctors, feel isolated and overwhelmed, and before we know it, consumed by worry and insecurity.

Medical training does not equip us with business skills, yet many of us are small business owners. At times I truly believe that learning all the branches of the facial nerve was inconsequential when compared to learning how to pay the BAS on time or service overdrafts. But this is real life post fellowship. The answer? Becoming and staying connected to your peers, and asking and receiving help.

The RANZCP strongly advises we form peer review groups post training in order to discuss clinical cases and obtain feedback and support. Obviously very important but way too narrow for most of us in private practice. In my time since fellowship I have forged and cherished some very strong relationships with peers that have nothing to do with discussing complex cases of schizophrenia, or the latest views on using antidepressants in bipolar depression. As a small business owner and sole director, my most valuable mentors are those who have done it before me, who are honest enough to admit their mistakes and can tell it like it really is. They have helped me understand how to run a practice in ways my training did not prepare me for.

And now, through social media I feel connected to other health professionals including doctors who have similar creative pursuits to mine. I have discovered a group of doctors who have a passion for writing, as do I. Now that registrar days are over I have pursued other areas of learning that matter to me. This has transpired into a feeling of connectedness, contribution to a community, asking for help and truly learning. 

As I embark upon my weekend of solitude and throw myself into finishing my first novel, I thank those who I have met and who have supported me to learn how to take a break, how to follow my passions, and how to actually make it happen. You know who you are. See you when I get back to reality.

Choosing to play 'win-lose' in negotiation and how it applies to #budget2014

Greetings all,

As promised, here is another key learning from my WMA caring physicians of the world conference at INSEAD this month.

During a very busy timetable we immersed ourselves in understanding negotiation skills and multi party coalitions. The same day, I watched the Commission of Audit report and discussions fill twitter feeds. I could see what was happening, the Federal Government’s strategy behind #budget2014 was clearly win-lose negotiation tactics, where the tool of choice is power not communication.

When a party or individual chooses to play win lose, they use their power to influence and win. They need to be very aware of the risk and believe the reward will be great enough to set off the risks. Win lose negotiations fall down when such parties overestimate reward and underestimate resistance.

So what does this mean in the context of the last few days? Well, choosing to deliver a budget that is harsh, hits the most vulnerable that a society should protect, doesn't contain a lot of information about how these measures could even be implemented, and then states that it will help Australia out of a perceived economic mess, may be overestimating reward.

I don't see reward when it comes to the $7.00 copayment. I have spoken to a patient who takes warfarin, who told me that if the copayment for pathology services go through, they will take their chances rather than have twice weekly blood tests. 

As a psychiatrist, I may no longer be able to prescribe lithium as often, a fantastic medication for bipolar disorders, as lithium monitoring is crucial with weekly blood tests needed to avoid kidney and thyroid disturbance. The ridiculous aside to this is that lithium is much cheaper than newer atypical agents and more cost effective for government. But, if my patient doesn't return, doesn't have regular monitoring, and develops renal dysfunction, they will then be knocking on the bulging doors of the emergency department. For the sake of making a GP or pathology centre claim $7.00 from a patient, because, after all, they have lost $5.00 per consult, costs and burden of disease will only but rise.

What will we see playing out in the next few days? Parties that choose win-lose and underestimate resistance will feel they have won for a little while until key stake holders form coalitions and lobby to block changes. Key stakeholders that have been shut out of any discussion about this most important budget, and all important patient groups will lobby via all channels available. Let's see what win-lose really looks like in a few weeks, and at the next election.

Then, a word of advice for all, using 'win-win' in negotiation requires communication. How about Government communicate with RACGP, GPRA, AMA,  and  include doctors rather than just rule them, or reduce them to workers of another branch of the ATO.

Thoughts?

Helen

Leading from the Couch - Psychiatry and Leadership

In just under a week, I will be attending the World Medical Association (WMA) Caring Physicians of the World Leadership Program at the INSEAD business school in Singapore. I will be one of a number of delegates from around the world representing our respective local medical associations. I am attending as a psychiatrist and will be learning and engaging as much as I can to become a better leader in this most challenging and important area of medicine.

Although a terrific honour, this is also confronting, and has led me to ponder what it is to be a psychiatrist and a leader? And even more importantly, can we still call ourselves leaders in debates around mental health or mental illness?

In a world that is post de-institutionalisation, over time more and more non-government organisations, consumer lobby groups and front line services such as Lifeline do an amazing job at helping people in crisis, enhancing the awareness of mental illness and attempt to reduce stigma. Government funding is directed at large organisations so that they can fund projects and inform the metal health debate. Office bearer positions within these organisations are not reserved for psychiatrists but a range of mental health clinicians. In fact WE are largely being labelled 'mental health clinicians' when we are Psychiatrists with medical degrees and post graduate training. And although funding and awareness is all important, I should not be at the expense of evidenced based care that psychiatrists are trained to deliver.

Today on Twitter, SANE posted a comment from their CEO, Jack Heath. In a recent comment in the Age he stated that more than 2500 people died by suicide in this country in 2012. He described this as deeply concerning, not least because it is the highest number of suicide deaths in the past 10 years. He called for collaboration between clinicians, NGO’s and Government. He believes mental health clinicians need more skills in recognising and managing suicidal tendencies. But what about psychiatrists, who are trained in this and can do this work being engaged in this debate. Actually, why aren’t we leading it?  

I am concerned about the ‘dumbing down’ of a profession I am very proud of. When I have a patient in crisis and need to call crisis services, I rarely get to speak to a medical colleague. Imagine a cardiologist sending in a patient to an emergency department with chest pain only to be told he cannot speak to the admitting officer, another doctor. And psychiatrists are largely losing traction as leaders in hospital multidisciplinary teams. Policy is often informed and determined by others.

Two ways I see that psychiatrists will continue to experience challenges as becoming leaders in the mental health debate:

1.    The Monash University Medical School now offers a course titled 'Medicine of the Mind' rather than psychiatry. I can only imagine the outcry if they offered orthopaedics as ‘Medicine of the Bones’. Not only is this a watering down of our skills and abilities, it may discourage medical students becoming future psychiatrists. Medical students need to be educated that psychiatry covers more than just the mind.

2.    On 16 April 2014, Dr Murray Patton, current President of the Royal College of Australia and New Zealand Psychiatrists (RANZCP) spoke on ABC Radio National about addressing community misunderstanding about psychiatry. He reported results from a survey of 1500 members of the public in Australia and New Zealand, which will be released shortly. Perhaps the most staggering finding was that more than half of Australians (56%) are unaware that psychiatrists have undertaken medical training as a doctor, and 15% of the community incorrectly thinks a psychologist has medical training. This would be unthinkable in other specialities in medicine, and one ponders how this has happened? If patients don’t know what we do, they may not feel comfortable being referred to us. Hence the barrier to effective evidenced based treatment widens.

So, I will be heading to off to Singapore, as a medical doctor, passionate about psychiatry and willing to work out how I can become involved as a leader in this very important debate. The incidence of mental illness is a global concern, a local issue, and we need a strong empowered medical workforce for generations to come.

Please tell me this is not happening...

Ok, I haven't worked in the public mental health system since 2009. OK I might be misinformed. But I am hearing more and more from colleagues that a reduction in staffing in public hospitals is leading to increased use of major antipsychotic medications to sedate patients, so they require less intensive support and care. Known as 'chemical restraint', this method is being used over safer methods during the acute period a patient may be agitated and require transportation. Now, anybody who has not witnessed first hand how unwell and distressed patients with acute mental illness can be may find this diffiicult to comprehend. But doctors and nurses are duty bound to ensure they keep patients safe from themselves and others until better. The safest way is to use trained staff to calm patients, proivde one on one support and supervision, in a low stimulus environment. The same goes for patients who are agitated and distressed from head trauma or brain infection as well. Hospitals should be able to rely on teams of trained staff to use their expert skills to contain patients, thus minimising the need to use antipsychotic medications to achieve this.
However, the word on the street is because of staff shortages and more acuity in patients, the use of chemical restraint is becoming more routine in situations where patients need to be transported or contained. Chemical restraint is achieved by injecting medications used for illnesses such as schizophrenia.
So, what happens to patients when they are given cumulative doses of major antipsychotic medications? Well, they may experience respiratory depression, ie unable to breathe effectively, and may end up with pneumonia. They may experience severe side effects of potent medications, particulalrly if already on regular doses of medications. And when chemically sedated, they can't alert anybody that they may be experiencing symptoms of this.
In no way am I blaming the staff who do a superb job working with patients who are very unwell. I am blaming a public health system that looks at dollars, cuts brutally and without consideration, and I feel for the vulnerable patients with acute mental illness that suffer as a result.

Ahhhh, families...

It must be January. Not because it's so hot, the tennis is on, and the traffic is slightly better in Melbourne at the moment. Because my patients tell me so. Because they have endured Christmas, and now feel the pain. They have spent time with their families, and this hasn't always been a great thing.
Why do we feel compelled to 'celebrate' with those who push our buttons and trigger our vulnerabilities? It's common for some patients to strengthen throughout the year, resolve to rise above  dysfunctional dynamics, be confident in their decisions, only to undo this on 25 December. They feel obligated, emotional blackmail is unleashed and they spend time with those they avoid for 364 days of the year. The in-law, the grandparent, the cousin, somebody who has caused pain in the past is bestowed way too much power, and all is unleashed as if it was yesterday.
Somebody once told me that Psychiatrists invented Christmas to ensure there was plenty of work to do in a slow, cold European winter. More than just a joke. Time to roll up my sleeves and offer some healing for the next few months.