When we think of someone who has suicided, there is all too often the thoughts and wishes of "I wish he/she had asked for help" or "I wish I had known how bad things were". It is is very often implied that the person was suffering in silence and regrettably this is all too true at times.
However, there is also a large group of people out there who simply cannot fight the system anymore. That is what I want to talk about today because at the moment that is by far the category I would fall in to. I have attempted suicide in the past and when I look back, it was often intrinsically linked to the desperation of not being able to find the right help. I would come up against barrier after barrier and it was that energy of fighting so hard and being rejected by the very system meant to help me, that made things so terribly difficult so many times. Unfortunately, Psychiatric help is increasingly hard to access and unlike seeing a GP for example, the system seems to be actively working against you.
So this, in turn, forms a group of people largely unspoken for and without a public voice. When a patient in this position eventually cannot take it anymore and ends their lives the onus falls onto their loved ones to search for answers and wade through guilt about how they could have supported their loved one more, or got them to help, anything to save them. However, that guilt and anger should instead be directed at a health system that is still designed to deal with Mental Health in an overall incompetent way.
What so many people forget or merely don't understand is when you have been battling Mental Illness for much of your adult life, the exhaustion does not come merely from that battle alone. It comes from having to tell your story over and over and over again, essentially re-traumatising yourself in order to see a new GP, Psychologist or Psychiatrist. Add on if you have any form of hospital visits, you get to tell your story all over again to another complete stranger. Each time you see someone new, you have to start again with the hope that this person will be the one to help you. Unlike going the GP for a Cold or even something more serious, you don't necessarily need to "like" your Doctor. But in any therapeutic relationship, there has to be some sort of connection otherwise it simply won't work, so you may have to try 2, 3 or 4 people before you make that connection. This means staying strong throughout telling your story over and over again, which I can tell you is not easy when you are feeling well, that alone when things are not going well.
Then we come to the costs and waiting times. Someone who is experiencing severe depression can see their GP and be referred to see a Psychiatrist who they get home to call, full of hope that this person will be able to help them, only to find that they can get an appointment in three months time. So again, the fight rages on, but a little bit more is lost. Because of where I previously lived I was only able to access a Psychiatrist via Skype for the past year. This was a new and not overly effective experience after having lived in Sydney and seen the same Psychiatrist twice a week for the past 7 years. I told her in a recent session that my antidepressants are not working and that I felt we needed to look at something else. She responded by saying she felt she has tried everything she can and that I should get a second opinion. Now I had a couple of problems with this, for obvious reasons. Throughout my time with this particular Doctor we have tried several medications, some have worked and some haven't. With no warning whatsoever she slammed on the breaks and basically told me she had given up. I don't have a major problem with a Doctor asking for a second opinion, but when I asked for a recommendation of exactly who I might ask for that opinion I got nothing. I was told to just ask my local GP. Really? You’re a Psychiatrist and you've never met any others? You don't refer patients to any other Doctor's? Ok then....
I am the patient.
If I ask my Specialist Doctor for the name of another Specialist in their field one would think they would have a range of names they would know through their professional interactions and career. This is again where I have a major problem. If I had a serious physical condition and my Specialist was seeking a second opinion, would I be the one to organise that? Would they at least give me the names of some trusted colleagues to see? Why is it so grey when it comes to Mental Health? The same logic just doesn't seem to apply. Instead, I was directed to a GP that I hadn't even seen yet. So whether or not this is the case, the message you are sending me is " I actually really don't care and you can fend for yourself", which is essentially what I had to do.
So to continue on, at the same time this happened I had just recently moved to a new area, so began the hunt of firstly finding a new GP. Now for me, this is step one, because for me the GP is crucial in my network of health providers because they kind of sit in the middle and you need that to be a strong relationship that has your back and can liaise with anyone else involved. Regarding Mental Health, it's a bit of pot luck with GP's, you can find one who has no interest whatsoever and I have met more of those than I care to remember, or you can be lucky and land on a good one as I had in Sydney. So I was lucky, I found someone who was extremely kind, had a keen interest in Mental Health and took the time to hear what my needs were and where I was at just now. So job done on that front. Now that I needed to find a new Psychiatrist, that was the next enormous hurdle to climb. So on we go with the next step to find a local Psychiatrist who can do both my psychotherapy and also look after my medication. This is again something crucial to me that they are able to take charge of both. Now let me clarify that the area I have moved to is only on the outskirts of Sydney and in a significantly large health district. I asked if we could look for someone who had an interest or skills in Borderline Personality Disorder as a first preference. Unfortunately, this is a rare occurrence because the stigma of BPD is possibly almost as strong in the Healthcare Profession as it is in society. So after waiting another week, I went back to the GP and as I thought, there was not one Psychiatrist that she could find anywhere near me that had anything to do with BPD. So we moved on, I said that we could widen the net to someone who specialises in trauma, Major Depressive Disorder that has shown to be treatment-resistant, Generalised Anxiety Disorder and PTSD. All fairly standard stuff one would think when it comes to Psychiatry.
I am the patient.
Now, this is where I have a major problem with the system and why I know from experience that it can potentially cause immense suffering and if the person is already in a crisis, can lead to a significant risk of self-harm and suicidal thoughts and behaviours. You see, I am the patient, I go to the Doctor and lay myself bare at their feet for help. I appreciate so much that I have found someone who is kind and caring. What I do not understand is that from one week to the next appointment there is literally nothing done to research and prepare the next steps of my recovery. Let's put it in another context and I think it will make much more sense. If I went to the Doctor, had blood tests that revealed I had Cancer, I would immediately be referred to the relevant specialist. I wouldn't have to find that specialist myself or wait another week for my next appointment to roll around and see how we go, my Doctor would do that for me because again, I am the patient.
So when I got to the Doctor on Wednesday, she brought up her computer and started looking at Psychiatrists, basically asking me to pick off a screen of names that I had no knowledge of or any clue whether they are any good or now and asked which one I would like to see. This website she landed on gave an approximate wait time for an appointment as well. So blindly, I picked a female Doctor whos "bio" seemed to fit the bill. I was given the phone number on a piece of paper, told to go home and call them and make an appointment, after which my GP would provide the referral. I could literally feel the emotional blood boiling up. Why, why do I have to all the leg work to find someone? I am the patient. With one, ONE, option in hand, I go home, call the number only to be told that this Psychiatrist is not taking any patients for at least nearly four months.
Immediately I felt things snap. Back to square one. I called back my GP and asked them to pass on the message that I couldn't make the appointment and now I have to wait another week to see the GP again to see what the next steps are. This is what I want to be really clear about. I am fighting, every single day to try to find the resources to help me, I do everything my Doctors tell me to do, I take all my medication and I follow their advice and always have. So feeling the panic building up inside me, I decided to continue to be proactive and call the "Community Mental Health Team". A very blunt woman answered the phone and asked what I wanted. This is basically how the conversation went.
" Hi, I have just recently moved to the area and am having trouble finding a new psychiatrist. Given that you are the community mental health team, are you able to help me in any way to find someone?"
"No. You have to be a patient in the hospital for that to happen. Can I ask what it's regarding?"
"Umm my Mental Health!?!?!? I have just said that I am new to the area and need a new Doctor and figured you were a community based serviced based out of the public health system that you may be able to direct me in the right way in order to find someone"
"We don't do that. You can always google Psychiatrists in your area and then call around to see if you can get an appointment, otherwise, if you are feeling suicidal now, you can come to our triage department and we can assess you for admission"
" Ok so just so I understand, your advice to me is to either google doctors myself or come and in get assessed. I would think after that process I probably will feel more suicidal thoughts than I already am having which is great, so thank you very much for your help"
I am the patient.
I felt my trigger of rejection snap in an instant. This is the joys of BPD, my emotional response to a situation is exponentially larger than someone not suffering with it. I felt utterly hopeless and once again it fell to my family to try and pick me back up again to keep going and remain positive that something will happen to turn the tides. My mind raced with thoughts of why, why do I always feel like I am the one scrambling to find help. I'm 39 years old and have gone to every appointment you can imagine, yet I am still fighting every day, every week to find the right treatment. When I was in Sydney the barrier was that I couldn't work and get the help I needed at the same time. I lost jobs at the end of my time in Sydney because I told employers that I had a Psychiatrist appointment. The main career that I was in for 7 years sent multiple letters to my Doctor if I had time off to make him fill out forms about my Mental Suitability to do my job, a job I had received numerous awards and accolades for. It was utterly exhausting.
It was like waging a war on all fronts. My own private battle, the stigma that exists around Mental Health in the Corporate World, and door after door slamming in my face from the Health System.
When we talk about the "battle" or "fight" of Mental Illness, for me 80% is the illness itself and 20% is the system that actively fights back against me, making not only my illness worse and my life more chaotic, but it also has a profound effect on my loved ones. At times that 20% is far more dangerous for me than the other 80%. It's because it leaves me feeling like there is no hope, that I am doing everything I can to wage a daily war and the constant knock backs from the Health System is something that I struggle with immensely. The pressure it puts on my family is quite simply unfair, they shouldn't have to get nervous every time I go to a Doctor's appointment.
I am the Patient. We are the patients.
I imagine there are a lot of people out there like me. Whether you are a loved one that cares for something suffering Mental Illness or whether you are riding the rollercoaster yourself, we have to stay strong. We cannot be the forgotten ones that fall to our knees after so many years of fighting and trying our hearts out to make a better life only to have it ripped away by a system that at times feels like it actively works against us. My hope is that the stronger I get, the more of these sorts of stories I can tell, is that I can one day make some sort of difference. I often think of how incredibly lucky I am to have the support that I do and how frightening it would be to not have that support.
I am the patient. But I am also a warrior and I will fight until I win because what currently happens to people like me just isn't right. If someone doesn't stand up and say it no one will. So here I am.