Our Mental Health System? More Mental than Healthy!

My struggle with Mental Illness has been a long one. My first memory of mental illness was development of Body Image issues and an Eating Disorder in 1998 - I was 11 at the time. Later I started Cutting, initially as a way to help control feelings of hunger and then later as a way to control everything. By the time I reached the end of High School I was "living" on mostly Diet Coke and Crown Mints, and Cutting between every class. I indulged in a few other self-destructive behaviours and was sexually assaulted a number of times.

I've had various diagnoses over the years, enough that my official diagnosis is probably "Complex". The first was ADHD, followed by Depression, Anxiety, Borderline Personality Disorder, Complex PTSD, Bipolar - Aspergers has even been suggested briefly. My current Official Diagnosis is Bipolar Disorder.

I've had a lot of experience with Mental Health services in both South Australia and Victoria. I'm lucky in many ways - I'm a young, white, self-aware, well-educated, well-informed female-bodied and female-presenting person, so service providers are not threatened by me and don't feel threatened by me. I also have very good Private Health Insurance, courtesy of piggy-backing on my Parents' - so occasionally I can access Private Services.

Thing is, often those services are really hard to access! I'm great with search engines - thanks to a librarian Mother - so it's easy for me to find where the services are. Actually getting help from them? Not so easy.

In South Australia I was repeatedly turned away from Emergency Departments while in a crisis - on one memorable occasion the Psychiatrist on call told me "if you're that eager to kill yourself, just go and do it". Psychiatrists were hard to find, and generally unhelpful. When a Psychologist I was referred to made me feel deeply uncomfortable in our first session, I had trouble getting a referral elsewhere.

My experience in Victoria has been slightly better. Monash Medical Centre treated me in the same way that the Royal Adelaide Hospital had on its "best" days - kept me in Emergency overnight and then sent me home with a "don't do it again" the next morning. I quickly found a Psychiatrist with whom I developed a good rapport and I had the option to see a Psychologist. I also got a referral to CASA (Centres Against Sexual Assault) - the first time anyone had suggested specifically dealing with the sexual assaults I had suffered. CASA were very good to me in the one over the phone and one in-person interview I had with them - but I found talking about my Sexual Assaults to be more harmful than helpful. I must note that it's possibly for the best I decided not to see CASA long-term - their waiting list is a number of months for regular support.

In late 2009 I had two admissions of a month each to Pinelodge Clinic in Dandenong, under the care of my regular Psychiatrist. Getting a bed was quick and easy and I fared reasonably well in the hospital environment. I found that Mental Health clinics are lonely places if you don't smoke, but I contended myself with books and DVDs. Most of the Group Therapy Sessions were geared towards people in a much later stage of life than myself, and thus had limited usefulness. The care from the Nurses was also variable - some Nurses behaved like they had all the time in the world to talk to you, other's made you feel like you had to tell them you felt OK so they could get back to other work. While I knew they were around, I was never offered use of the hospitals Psychologists.

Because I was admitted under my usual treating Psychiatrist, continuation of care post-hospital was pretty much assumed so there was no effort made to set up other supports for me. This made things difficult when I had to move house suddenly - making my Psychiatrist 3 hours travel each way from my home. I stopped seeing that Psychiatrist, saw a Psychologist briefly but unsuccessfully, and "maintained" my Mental Health by playing chicken with a medication that had fantastic mood elevating benefits for the first few days after increasing a dose, but then dropped off just as quickly.

I moved house again, to the inner city, and got a referral to a new Psychiatrist. For a while, things were going OK - at least by my standards. My mood swung fairly quickly from one extreme to another but after this long I kind of knew how to deal with it. Then suddenly, after a couple of weeks feeling flatter than usual, my mood took a nosedive.

St Vincent's is my closest Emergency Department and I headed there as soon as I was certain what my mood was doing. The staff there were fast and amazing - they took me very seriously, treated me very well and gave me what I needed. I hadn't slept for a few nights, so they knocked me out with the only drug I knew would put me to sleep (they also took my word on that, which is rare) and let me sleep as long as I could. I saw four different Mental Health Staff and every single one of them treated me with absolute respect. It was like nothing I'd ever experienced before. We agreed that another Private Psych Admission was probably required, and they sent me home with some sleeping meds and a promise that a bed would materialise soon.

That was where the problems started.

The reason I didn't get a bed straight from St Vincent's was because it was the day of the Grad Final repeat and there weren't enough Doctor's on duty to admit me (no, really). I was told there were beds at two Clinics and that I would get one the next day.

Now, I should probably explain the Private Clinic System in Victoria - at least in so much as it was explained to me. There are two ways of getting a bed -

1. Your regular Private Psychiatrist has "admitting rights" at a clinic and they refer you there and oversee your care while an inpatient
2. A company called "Bed Brokers" attempts to find you a bed and a Psychiatrist to go with it.

St Vincent's decided to go through Bed Brokers - it was a Saturday and I communicate with my Psychiatrist by email only so trying to go through her was thought to be less effective. As I say, they were told there were beds and that I'd be getting one, and they sent me home.

I should say here, I have excellent Private Health Insurance - apparently the best you can have in terms of Psychiatric Admissions in Australia. Not only was I obviously and critically ill, I was also worth hundreds of dollars a day to whichever clinic took me in. Surely if my condition didn't get me a bed, the money would - right?

I slept reasonably that night - a mixture of the meds I'd been discharged with and the knowledge that I'd be admitted the next day.

I was woken at 9:30am by a call from The Melbourne Clinic. They said "We've reviewed you and don't think you need to be here. Talk to your private Psychiatrist maybe they'll think you need to be somewhere they have admitting rights". It felt like a kick in the stomach. I'd been told everything would be fine! They'd promised!

Eventually I rang Psych Triage at St Vincent's who were as amazed as I that The Melbourne Clinic had rung me, and at what they had said to me. Apparently The Melbourne Clinic had gone against usual procedure in contacting me directly, and St Vincent's weren't sure what to do. They promised me they'd sort something out and we hung up.

Less than ten minutes later they rang me back. They had spoken to Bed Brokers, who were equally surprised at The Melbourne Clinic's actions. They were sorting things out and I was just to hold tight and ring them back if I had to. I sat tight indeed - afraid to leave my bed in case I my impulsive mood made me do something stupid.

I got another call from them just after Midday - there was no chance of a bed that day. Also, the reason The Melbourne Clinic rejected me was because I have a private Psychiatrist and they didn't want to "interfere".

I don't know how to explain what making yourself do things is like when you're depressed. Basically, it's really hard. And when I'm in a Mixed State (which is what I was technically in) I feel like anything I do will be the tipping point which makes me do something stupid. I had reached out for help - and it was hard to do so - and I was getting slapped back constantly.

I was advised to email my Psychiatrist, see if she had admitting rights anywhere. She replied that she did not admit patients, and that if I needed an admission and presented to an Emergency department that they should organise it. She said this was how it was done at the Royal Melbourne where she works.

I rang and told St Vincent's about this and they told me they were doing what they could. They continued to be kind, courteous and helpful to me the whole time. Staff I had spoken to before remembered me and told me I'd spoken to them before and didn't need to repeat myself.

Later, I got another email from my Psychiatrist saying she was worried both about me and about St Vincent's response. She said they (and Bed Brokers) should be aware not all Psychiatrists do admissions and that she would call me the next morning during her shift at in Emergency at the Royal Melbourne - I was starting to wish I'd gone there, despite how good St Vincent's had been to me.

Rang St Vincent's again to keep them updated - spoke to the guy who had admitted to Emergency on that first night. He said he was surprised by the "run around" I was getting and said I'd been treated "bloody appallingly". I was inclined to agree. He put a note in the system for my case to be followed up in the morning and said he was there all night and to call or come in if needed.

I wrote in my Livejournal after that phone-call

"It's kind of gotten to the point where this is all so hard and ridiculous that it's almost funny. I'm almost becoming slightly hysterical about the whole process. Basically, if I was less responsible I wouldn't be having this trouble. If I didn't balance my money enough to see a private psych regularly I could have been admitted. Or if I hadn't recognised that I was at the "doing something stupid" stage and gone to the hospital BEFORE doing said stupid thing I probably could have been admitted as a more acute patient. I understand that the system wants to minimise hospitalisation of people...but surely it's better that I get help now when I want it rather than wait until I've decided that it's just not worth it? I'm almost at the point of wanting to do stupid things just to force them to GIVE ME SOME GODDAMN HELP."

At 9:30 the next morning, my Psychiatrist rang and said to come and see her at 1pm. Immediately afterwards, St Vincent's called to say they had spoken to their head Psychiatrist and Bed Brokers and they were still trying to sort things out. The woman from St Vincent's had seen me briefly while I was there and said she was sorry, and that she was "really angry" with how "broken" the system was. She also said it might be a matter of days until I got a bed.

I actually went in to the office that morning. I was so all over the place that I actually felt safer out in the world where people were watching me and I had to behave in certain ways than at home by myself. When I left to see my Psychiatrist I told them I'd be back in the afternoon. As far as I know, they had noticed nothing wrong - I've always been good as Passing As Sane.

While I was on the tram, I got a call from Bed Brokers to say that they'd found me a bed after all! I cried with relief - right there on the tram. The Victoria Clinic was willing to admit me under a different Psychiatrist. I didn't have long to get there, so after a quick stop at my Psychiatrist's office to get a letter to take to the Clinic, I headed home to pack, email my boss and write down people's phone numbers in case they took away my phone - Pinelodge confiscates phones, The Victoria Clinic doesn't it turns out.

The admission process was long and tedious - and having a shared room threw me quite a lot - but I was finally safe. Finally somewhere where other people could pick up some of the slack.

Hospital itself was a mixed bag, like the last two times - lonely and invasive in turns, not geared at my age level, variable nursing care. The Psychiatrist they assigned me was amazing. He took a much more radical approach to my medication than anyone had before and just in the short time I've been on the new regime I think it's a good plan.

Of course, not everything is sunshine and roses - Lamotrigine (also known as Lamictal), which is being used to treat my rapid cycling Bipolar, is not on PBS for my condition. It's not a drastically expensive drug, but I do have a very tight budget. Seroquel XR, a drug I need to keep me stable during the day and allow me to sleep at night, is only available to me on PBS for 6 months. After that, I either have to take it with Lithium (which is kind of toxic) or Sodium Valproate (which I can't take because I have PCOS) to keep paying PBS rates. The non PBS rates are about $300 a pack. I'm also on an anti-depressent, an anti-anxiety pill when I need it, and another medication to help counter the nausea and dizziness caused by all the other drugs. For all this (plus the pill for my PCOS, and medication for my asthma) Centrelink gives me $6 a fortnight as a "Pharmaceutical allowance".

I'm LUCKY. I know where to go and try to access the help. I can advocate for myself, to some degree. I have a privileged background - some vestiges of which remain. I understand a bit about the medical system. I understand myself.

If it's this hard for me, what is it like for everyone else?

The system is BROKEN. Who's going to fix it?