The need for public inpatient eating disorder treatment

Today I attended a forum for consumers and carers to discuss the 10 Year Mental Health Services Plan, facilitated by the state Mental Health Commission. The four categories discussed were bed based services, community clinical services, community support services and prevention & promotion. There has been talk of this already, but one of the points I raised under bed based services was the need for a specialised inpatient eating disorders program for adults. Currently in my state there’s an inpatient eating disorders program at the children’s’ hospital for those under 16 years old, and for adults there’s one at a private hospital which is only accessible for those with private health insurance. In the public mental health system this is non existent, so you either get put in a general acute mental health unit or you get nothing.

This is problematic for a number of reasons. As we all know, the number of beds in psych wards are limited, and there’s almost always greater demand than there are beds available. Most beds are occupied by those who are suicidal, have psychotic or affective disorders. Even those who are suicidal sometimes get turned away. So if you have an eating disorder, unless you’re quite underweight or physically compromised, there’s slim chance you’ll get inpatient help for it. It seems as though EDs being treated in acute psych wards are so rare that nurses were quoted saying to me “Last time we had an eating disorder patient here….” It’s hard enough to eat and recover with supervision and inpatient care, I imagine it would be even harder to do so on an outpatient basis. It just doesn’t seem fair that it’s so hard to get that help if you’re in the public system.

Then there’s the care for when you are an inpatient. It’s better than nothing. But there are also many reasons why an acute psych unit isn’t appropriate. I get that it’s hard to cater for everyone, but often groups weren’t all that relevant. I know that at the private ED program, the groups offered are actually somewhat relevant to those with EDs. The focus while I was inpatient was all on just food and weight and there was nothing to help with the psychological side of it.

There were some staff members who did seem to have experience and knowledge of EDs, but then there were others who did not. I got nurses from one extreme, who told me I’d eventually be dead if I didn’t come to hospital, to the other extreme who asked me “Why are they so worried about you anyway?” and told me “I thought you’d be home by now.” I got the feeling some nurses wondered why I was in hospital and didn’t think I needed to be there. There were nurses who didn’t seem to get that it’s not that easy and would tell me “Just eat and put on the weight so you’ll get to go home, simple,” as if there wasn’t a battle going on in my head when it comes to doing so. When I was caught exercising and told to stop by the nurse, “Put on the weight so you can get out of hospital, then when you get home you can do what you want.” Lol, kinda defeats the purpose of being in hospital, but ooookay then.

There was even one nurse who asked me how I managed to lose weight on more than one occasion. Eventually I asked her “Why would you ask someone with an eating disorder that?” There was a particular conversation I remember she was having with my friend on the ward and myself. The nurse was talking about being envious that Asians are all so slim and and asked me how it is that Asians do stay slim and what they eat to do so. “Rice,” I answered. She laughed and said no, she’d probably gain weight if she ate rice. This conversation was upsetting to me as I feel like I’m meant to be thin because I’m Asian. Because I’m Asian, even at my lowest weight, by Asian standards it’s not even considered skinny- just average. And if I gain weight and go back to my highest weight of ~43kg, it’ll be considered fat for an Asian.

Then there are aspects that I, or rather my ED, likes that some staff aren’t experienced. Times when my Ensure Plus has ended up down the drain rather than down my oesophagus and into my stomach when I haven’t been watched or watched closely enough. Times when I’ve managed to hide and/or throw food in the bin. When at a mealtime a nurse has said, “I’m meant to watch you eat but I won’t, just makes sure you have everything you’re meant to have.” Lol, sure I will. It seems like some don’t realise how sneaky eating disorders can actually be. Before I got caught out, I managed to go a few times to weigh in wearing multiple items of clothing and hiding extra weights on me. A friend who’s been through the private eating disorders program couldn’t believe I’d gotten away with that- it seems that over there where they specifically treat EDs, they’re a lot more clued in to the tricks that people with EDs use. One morning when I’d been up early, I blatantly had two cups of coffee before weigh in and didn’t hide it, and they didn’t pick up on it or say anything and weighed me as usual.

One advantage I will say though of not being in a specialised eating disorders program is that I was the only one in the ward at the time being treated for an eating disorder. I worry that if I were to attend an eating disorder program, I’d be triggered by patients who were thinner than me, or who ate less than me. When you’re the only one in the place who has an ED, there is far less competition for who can be the thinnest, who can be the sickest, who can eat the least.

Banned from blogging (but doing it anyway)

Well thank you to whoever reported me/my blog to the staff at this hospital. Not happy.

On Saturday night the registrar came to see me, and it was brought to my attention that they were concerned about what I post on the internet. I asked them to clarify for me what exactly it is I’m not supposed to be posting, as I have many accounts on social media and couldn’t be sure what they were referring to. I was told I’m not allowed to post about myself because “You’re under the Mental Health Act” and “We have a duty if care to protect your reputation.” I call bullshit. Protect my reputation? More like protect their reputation. It’s not like I even use my full name in association with this blog.

Sunday night nurses and security guards came into my room to search it again and that’s when I got angry and tried to take off. Unfortunately they caught up to me in the car park, I was again restrained, put in the seclusion room and sedated. Fun times. My hands are now all bruised from when I punched and hit the wall, and I was knocked out the whole of yesterday from the two shots of midazolam and 100mg of chlorpromazine I was given that night.

The consultant on my team is back from leave. Apparently I’m not meant to be blogging as my reports of being restrained and secluded can “give people the wrong impression of what happens here” and can perpetuate the stigma of mental health. “I don’t write anything that’s not true,” I shrugged.

A tentative discharge date has been planned for this Thursday, as well as a discharge meeting with my mum. The sooner I’m out of here, the better, I say.

Review into the WA mental health system

Earlier this year I, together with a friend, met with Professor S to share our experiences with the mental health system. We were only two of the 891 people interviewed for this independent review into the mental health system in our state. What prompted this review were suicides that occurred after a person interacted with A St (yes, the community mental health service I briefly attended) and did not get the help they needed. For example, one young woman completed suicide the day after being discharged from A St, despite attempting suicide on the ward only the day before. Her suicide attempt was dismissed by clinicians because she has a diagnosis of Borderline Personality Disorder.

The report was finally released this week and can be found here. Though I am appalled at how many gaps there are in the system and how horrendous some peoples’ experiences are, I can’t say I’m surprised either. It just makes me angry that so many people have been let down and continue to be. Three of my experiences are included in the Patients’ Experiences section of the report, and I’m not quite sure what to think about that. It feels really weird that many people, including the government, have read this report and may have read of what I told Professor S in the interview.

Apparently the government are taking action based on the recommendations that have come out of this report, but I can’t help being a bit cynical. After all, according to my friend, this report contains the same issues as a 1922 review. I guess I’ll believe it when I see it.

Psychologist not the right one

I did give it a go. I mean, this was my third time meeting with this psychologist, though the first in terms of seeing him on his own. But I think it’s enough to determine whether I feel I can work with him or not. Unfortunately I just don’t feel I can.

I already had my reservations from that first time when I felt misunderstood and pushed into treatment I wasn’t keen on. And today I think he pushed too hard too soon for me to talk, given it’s our first actual session together. If you’re going to ask me to talk to you straight off about the reasons around my OD which I feel quite embarrassed and ashamed about, no I’m not going to do so. It takes time for me to open up and whomever I’m seeing, I need them to understand that.

He was also rather blunt. Yes, I know sugar coating everything and treading too lightly isn’t going to be the most helpful. But a bit of sensitivity wouldn’t go astray either.

About halfway through the session I could feel myself reacting by putting a barrier up and becoming oppositional. My responses were more abrupt. My attitude became one of indifference. I again grew resistant to the idea of therapy and change. Within this mode I stubbornly told him that I don’t want help and that I’m fine with how things are. That it’d be a waste of time coming back and he’d be better off seeing someone who actually wants the help and is ready to change.  When asked whether I would come back for another session I said ‘no’. He told me he’d send a letter to my GP and I’ll discharged back to her.

How do I feel about that? Rather sick with anxiety really. I’m aware I’m choosing to throw away this opportunity for free psychological therapy that’s not limited by a certain number of allowable sessions. I know I’m lucky in that many people don’t get this kind of help. Just last week in the courtyard at A St I was reminded of this, listening to a woman sobbing to a nurse that she needed to see a psychologist but was still on a waitlist.  But at the same time, I don’t see much good in seeing someone I don’t feel at ease with and cannot open up to. In a medical setting it wouldn’t matter so much, but within the context of mental health being comfortable with the person you’re seeing is important. Within the public system you don’t have to pay and the number of sessions is based on need, but you’re stuck with who they give you. In the private system, the advantage is that you get to choose who you see, but it’s costly and limited to ten sessions per year.

Don’t really know where to from here. I guess I’ll just have t see how things pan out.

Upcoming Pdoc appt and Mentalism & Driving

It was surprising how many of the other patients when I was an inpatient didn’t actually have a regular psychiatrist. Many of them had their mental illness managed by their GP. Which has led me to believe psychiatrists, particularly those in the public system, are really for those with more severe mental illness like schizophrenia or bipolar disorder. If the statistics are correct, 1 in 5 of us have depression. In other words, it’s rather common. Too common to be seeing a specialist in the public mental health system for?

One of my fears when meeting with a new mental health professional is that they won’t take me seriously. Or they think I don’t really need to be seeing them as there are plenty of people sicker than me. I tend not to talk very much when confronted with mental health professionals. When it’s someone new who knows nothing about me, what if they take my reluctance to talk about my issues and struggles to mean that nothing’s wrong? Or assume that I’m deliberately being ‘shy and secretive’ as the first psychiatrist I saw accused me of being? Another barrier to talking is I can’t help thinking if I do describe in detail what I’m struggling with it will be assumed I’m exaggerating. That I’m deliberately talking up my symptoms to ‘prove’ I have depression and therefore deserve help.

Hopefully what may make tomorrow’s psychiatrist appointment a little easier is that D has been in contact with I, one of the clinical psychologists at A St, and told him a bit about me. While I’m not exactly keen on being discussed without knowing what’s been said about me, if it helps them understand a bit more about where I’m coming from I won’t object.

I’m meant to make an appointment to see my GP as well, but on top of a psychiatrist appointment on Tuesday and a psychologist appointment on Wednesday, a third appointment in a week seems rather excessive. I went to renew my Learner’s Permit in relation to driving and because I’m mental, the Department of Transport seems to be questioning whether I’m fit to drive. Being the honest person I am, I ticked Depression where it asked us to tick whether we have any of the medical conditions listed, and dutifully wrote down Pristiq and Seroquel where it asks for medications. I was then told because of that I have to have a medical, get my GP to fill in a form stating whether I’m fit to drive, and come back next time. Ugh, seriously? My ability to drive isn’t affected at all. And I’m smart enough to know not to drive after taking Seroquel because of the drowsiness it causes. Ever since I’ve been thinking I should have left those sections blank to save the hassle it’s causing.

Not on the DBT wait list

Is it really that much to ask that the hospital find out the eligibility criteria of a service before referring me? I spoke to D yesterday and apparently YRS is a mental health service for young people who are homeless. Which, living with my parents,  I am not. So it’s only now that a referral has been sent to A St, the adult community mental health service. Cool, why didn’t we find this out earlier so it could’ve been sent back in November instead?

In case you’re thinking the name ‘A St’ sounds familiar, yes it’s the same place that conducts the DBT program. The lady from YRS rang me back today. She reported she’d contacted A St to enquire about my status on the DBT wait list. Apparently I’m not even on the wait list any more. Umm, say what?! Maybe it’s my retribution for being so cynical and unenthusiastic about DBT, telling D yesterday I thought Linehan’s book “lame and patronising.” But I…lol, I don’t even know what to say any more in response to the inevitable debacle that occurs whenever I try to access mental health services.

YRS phone call & no BPD = no DBT

It’s odd when an interview to determine appropriateness for a particular service seems a bit like a job interview. It almost feels as though you have to sell yourself a certain way in order for them to accept you into their service. “What do you think you need help with?” Ummm…. “What would you want to work on the most?” Err…I dunno! Good thing it’s not a job interview, I wouldn’t be in with half a chance otherwise. The woman on the other end of the line at YRS (youth mental health service) told me she had looked up my health records and noticed I’d been referred for DBT. I confirmed yes, the psychiatrist at the psych ward had recommended I do DBT and thus the psychiatrist I was seeing at the time referred me to the DBT program a year ago. She said she’d ring A St (DBT place) to find out my position on the wait list, discuss with the team whether their service are able to accept me or not, and ring me back probably on Friday.

That same day in the afternoon I had an appointment with D. I told him of the outcome, in which the lady will contact A St and get back to me. D told me he was aware of the referral, but wasn’t sure DBT would be the best treatment for me though some of the skills could be useful. “Have you heard of something called Borderline Personality Disorder?” he asked me. I told him that I have. “Has anyone ever told you you have Borderline Personality Disorder?” I shook my head no. He told me he “doesn’t think I have it.” I couldn’t help feeling relieved and a little pleased upon hearing that. Though he also said it probably means I’m not eligible for DBT as they require a BPD diagnosis for admission into the program. No DBT for me? Gee what a pity… Can’t say I’m all that disappointed to be honest.

Mental illness in Indonesia

As much as I moan about the mental health system in Australia, it could be worse. I mean, I could’ve ended up living here in Indonesia instead, where I’m currently holidaying and visiting relatives. Would’ve, had my grandparents not decided to relocate the family to Australia over 20 years ago.

Of course, I don’t have any direct experience, nor much knowledge of the mental health system here. But judging by the situation described in this video, it’s nothing to be proud of. Even those who are anti psychiatry must admit that’s better than chaining people up with nothing but a bare floor and open sewer, with only ancient wisdom, prayer and herbal therapy as treatment. It makes public psych wards in Australia look like five star hotels.

Then there’s the beliefs held by a proportion of the people here. My aunt’s friend’s daughter has some mental health issues. She’s been to a doctor and attends counselling. Her relatives though believe that her issues are caused by black magic; someone wanting to harm her or the family. They’ve recommended she see a healer who will extinguish the supposed black magic. It’s a notion that sounds bizarre to most of us living in the western world. There are many possible causes of mental illness, whether it be trauma, stress, biological, abuse, etc etc. But what we do know is that black magic is not one of them. A belief that is not firmly held here. It isn’t the families’ fault though. There are cultural differences and a lack of mental health literacy and education and awareness programs.

I feel both lucky and guilty. Guilty when I read and hear about how people with mental illness are mistreated here. Guilty when I reflect on my life in comparison. Such states of poverty in this country; homeless people, dwellings in which naming them ‘houses’ would be generous, hard manual labour in which their wages in a day we’d easily earn in an hour. What right do I have to be depressed in my first world conditions and to receive competitively good mental health care? I admit that when I arrive home I’ll be relieved; relieved I receive the standard of mental health care there instead of here, relieved that I’m not reminded and guilt ridden everyday of how privileged I am, relieved I live in Australia instead of Indonesia or some other developing country.

My (non) referral to YL & no more Dr T?

I had believed the hospital had sent a referral for me to attend YL, the youth counselling agency, when I was discharged. That’s what the doctor told me before I left, that’s what D, the hospital psychologist, has led me to believe for the past three weeks. Today however, D told me this wasn’t the case. This error was only realised yesterday and so it is only now an ‘urgent referral’ has been sent. “How come?” I asked him. He replied something to do with ‘hospital procedures.’ Right. Guess I shouldn’t be surprised. I should be much acquainted by now with how inefficient the mental health system can be. I’m lucky I have a GP who takes action in ensuring I am linked in with mental health services, and I’m lucky the hospital has made allowances for me to continue seeing D temporarily as an outpatient. Otherwise this error may not have even been picked up and I would have fallen through the cracks and been left with no support. It wouldn’t be the first time that’s happened.

At the end of the session, D assured me that he can continue seeing me until I start with YL, and I also have Dr L, my GP. It didn’t escape my attention however that he had failed to mention a certain someone. “So is Dr T not seeing me any more?” I enquired. “That’s the impression I get,” he confirmed. Great, well it’s nice of people to explicitly tell me these things. I would’ve thought it’d be kinda important for me to know that the woman who’s been my psychiatrist for the past 1.5 years is now…not. I actually had an appointment scheduled with Dr T for the 20th of January. Do I now cancel it for the third; and last time? A year ago the belief that Dr T was going to stop seeing me as a patient was enough to prompt me to overdose. But now…I think maybe it’s for the best. The number of times I’ve left her office feeling more upset and at times suicidal… And I also suspect she declined to treat me as a patient when they were looking to admit me to a private psych hospital from the ED.

According to D, YL have psychiatrists. On their website though, it states, ‘The team is staffed by clinical psychologists, social workers and community mental health nurses.’ No mention of psychiatrists. If I’m right, the prospect of potentially not having a psychiatrist worries me a bit. But then again, lots of people with mental health issues manage without a psychiatrist, right?

NAC infusion in the ED. Again.

The months following my three week hospital admission in May, I had actually been going okay. Only one small overdose of paracetamol in over four months. Until this week that is. Wednesday night I took several antihistamines and a few different sedatives that I shouldn’t have had in my possession. Slept for about 16 hours. And what do you do the night after you OD? Why you take another one of course…

So what happened? I may as well link to this post made in August 2010. I’m predictable and stupid enough that I do pretty much the exact same thing over a year later. But of course there are always a few differences. Like the nurse who commanded “Show me your scars,” and then proceeded to try and draw them on my notes. The same  nurse who asked me, “Do you think you can be an occupational therapist with your condition?’ She also remarked to the student doctor that it’s “sad” I’ve been on the waitlist for the DBT program for so long as they poured over my file. Yes, ten months is a bit “sad” isn’t it…

A few people ‘had a chat’ to me, as they like to call it. The ED doctor treating me, the aforementioned nurse, a couple of psych liaison nurses and the psych registrar. Got the standard lecture about liver damage from the ED doctor and was told to pick up the phone and call someone instead, next time I want to OD. That simple, huh? When interviewing me, the psych liaison nurse commented that I’m not much of a talker and that I must dislike him asking so many questions of me. I replied that I “guess I’m kinda used to it.” “That’s quite sad really, isn’t it?” he answered. Guess it is quite sad I’ve been through four ED admissions, two psych admissions, three psychologists, two psychiatrists, a school counsellor and two GPs who all ask very similar questions. He’s also another one who seems to think DBT will be the miracle cure all. Given my views on what I’ve seen on DBT so far, really I just wanted to bash my head against a wall at his suggestion. I pointedly informed him I am on the waitlist for DBT and have been since January. “Would you like me to help bump you up the waitlist?” he asked me. I shrugged.

I had entered the ED at about 9am on Friday morning, the NAC infusion finished at about 9am the next day and my bloods came back fine at about 10am too. Which could’ve meant I could go home then, but no. I had to wait for the psych registrar. And it wasn’t a quick wait either. About three hours I waited around just for her to have about a 15 minute chat to me. I was presented with three options; home, the private psych hospital I was at in May or the public psych ward of the hospital I was currently in. I shrugged. And cried. A lot. Neither of those options were particularly appealing to me. Hospital for the reason that it’s well…hospital. Home for the reason that I don’t know how I’m going to cope when I don’t have ANY help at all. Last week I had to cancel my appointment with Dr T scheduled for October 7 due to reasons relating to uni, the next available appointment slot was November 16 so I took it. Which is now a month away. I’ve stopped with R, the psychologist I was seeing, and no, I’m not going back.

In the end Dr Chicken, the psych registrar (and no that’s not a pseudonym, no joke), decided to send me home with the proviso that my parents are around to look out for me and I agree to call someone and seek help if I’m going to overdose. Which I did, amidst much crying, express my reluctance and extreme difficulty in doing so. I know it may not seem that hard to some, but I can’t and find it really, really hard to call or ask for any help when I’m struggling. And if it wasn’t such a show of their inefficiency, it’d be somewhat amusing that despite Dr Chicken’s plan for me to call them, or the private psych hospital I was at, or go to the public psych ward triage, or whatever it was, I’ve been given no numbers to call nor any clear instructions regarding what to do if I’m feeling unsafe. Which is just excellent. Next appointment with your psychiatrist is in a month, and in the meantime goodbye and good luck.

And since being home I’ve been crying and contemplating taking another overdose, trying to convince myself otherwise. My exams being in just over a week isn’t helping matters either… :/ I feel so stuck and as if there are no options for help.