Is there no one approach that would make a significant difference to suicide rates?

The New Zealand Suicide Prevention Strategy 2006-2016 is a xomprehensive document, and in general it has covered a lot of the areas that need to be looked at in suicide prevention. some of its claims, though, are a bit shaky in my opinion.

Suicide is not a ‘quick fix’ issue and no one approach is likely to, on its own, make a significant difference. Like most complex health issues where there are multiple contributing factors, suicide prevention requires sustained action at a range of levels, and a commitment to investment over a long period of time. (p.14)

Consistent evidence shows that:
a. the majority of those dying by suicide or making suicide attempts have a recognisable
mental health problem
b. mental health disorders (including, in particular, mood disorders, substance use disorders,
psychotic disorders and antisocial disorders) account for up to 70 percent of suicides and
suicide attempts (p.15)

These two quotes add up to – there’s no one thing that will make a significant difference to suicide rates, but suicide rates are driven by mental illness. Would it not make sense that mental health treatment would be a key to driving down suicide rates?

I would suspect that the government doesn’t want to go down that path because it brings up how woefully underfunded mental health treatment is. Waiting times for people that need to be seen immediately are supposed to be same-day, but for those that are only ‘urgent’ priority the wait can be as long as 7-10 days. The guidelines only require immediate referral for ‘serious’ suicidal intent. So those who are immediately suicidal maybe seen on the same day, but those who are only potentially suicidal are shunted onto a waiting list too long for some. Who judges whether someone is ‘seriously’ suicidal? How many only sort-of suicidal people die in the week and a half it takes for an overloaded system to respond to their needs?

The government acknowledges that mental illness is the dominant commonality in suicides, yet it will not assign adequate funding to treatment of mental illness. Do they have some data that says that spending on a proper mental health system won’t help drive down suicide rates? I don’t think so. I think they’re not wanting to spend the money it would take to reform our mental health system, and therefore reducing the national suicide rate to an economic game of numbers. People’s lives deserve better, whether they’re at risk of suicide or mentally unwell in other ways.

Next step forward

I went to the psychiatrist yesterday, and we’re raising the dose of one of my medications. At least it’s not a new drug to trial. I hope it works.

Things are still going downhill. I’m getting intense anxiety when I drive again. I thought I was getting over that, but it’s back with a vengeance.

I’m struggling to cope with everyday things, like cooking a meal. I melt down more often than I have in months. If two people talk to me at once, it’s hard not to curls up into a ball and scream.

The answer to everything is ‘I can’t. Please leave me alone’, but I can’t say that. I have to keep going and trying to do things, or I might get even sicker. Or something like that.

Things aren’t good, but I’m sort of holding it together. I hope I get better soon.

Another Drop On The Rollercoaster

Today I went to see a private psychiatrist. The thinking was that it had to be better than the one I saw at CMH – after all, I had the choice to try someone else if it didn’t work out.

He was very nice, very gentle, and came up with the idea that I’m not actually bipolar, but have depression and PTSD. New meds, and more of a focus on other ways of getting well – he told me to eat better, go to the gym, do yoga, and take evening primrose oil.

I don’t know how I feel about it all. Jumping from diagnosis to diagnosis feels very unsettling – it feel like every doc has something different to tag me with, and a bunch of different ideas on how to treat me. I feel lost in a very stormy sea.

The evening primrose oil thing makes me feel edgy – he admitted himself that the science behind it is inconclusive at best, and it’s an expensive option. He also talked about fish oil, before deciding that evening primrose would be better. Again, fish oil doesn’t have much in the way of good science behind it, and I put a fair amount of faith in good science. Still, anything to be better right now.

I’m being started on venlafaxine, and very slowly titrating off olanzapine. Getting off olanzapine is important to me – it’s stealing too much of my life. But I’m not sure about venlafaxine. I’ve been on it before, and it eventually made me feel completely dead inside, no emotion at all. It worked to start with, but toward the end the absolute lack of feeling catalysed my (probably ill-advised) decision to take myself off my meds.

I don’t know how I feel about all of this. I’m going to try eating breakfast regularly, and go to the gym, and see what happens. Right now all I feel is misery and confusion.

Running out of options

I met with my case manager at Community Mental Health today. I’ve been asking for almost a month now to see a different psychiatrist, after the one I was assigned . . . well, didn’t work out so well. The news wasn’t good.

Apparently, the process to change psychiatrists in the mental health system involves having to see the relevant party again with another worker present and try to resolve the issues. Because I don’t feel like I can do that after that first meeting that left me feeling so beaten down, they can’t move forward with the process. My options are to go back to said psychiatrist or to look elsewhere for help.

A large part of me feels like I just can’t go back to him, that he was so disrespectful of me and so arrogant that I don’t want to go back into that situation. I feel like not going back keeps me safe from the feelings he triggered in me. But there’s a part that says ‘you’re sabotaging your own treatment by not going to him. If you don’t play the game then you’ll never get treated. You need to stop being so difficult and do what’s expected of you’.

I feel trapped by these two conflicting thought patterns. I don’t know whether I should go back, whether I’m just being stubborn, whether I’m flat-out wrong. Or whether I’m within my rights, that I shouldn’t have to go back to someone that treated me badly (badly enough that my partner was fuming as well), that I’m keeping myself safe by not going back into a situation that made me feel unsafe.

My partner and I decided that we would take another path. We have the resources to be able to see a private psychiatrist, so we’re taking that option. At least when you’re paying them, you get to have the choice of who you see.

I feel a lot of guilt doing this. Most people can’t afford this option, and they have to just take whatever the system throws at them and make the best of it. So I feel guilty for being able to short-circuit the system. But the other option seems so much less appealing.

Psychiatrists and the “I Know Best” Attitude, re-revisited

Last night my daughter had a nightmare. She’s only five, and nightmares are scary, so she woke up and started screaming for Mum.

I only know about this because my partner told me this morning.

‘Drowsiness’ doesn’t even start to cover what I’m like at night. I can’t be so out of it that I can’t wake up when my baby needs me. I can live with a whole lot of problems with meds, as long as it’s just me they’re hurting. Not when they affect my family. That’s a step too far.

So I did what I’m supposed to do if I’m having trouble – I contacted Mental Health. I don’t have a psych appointment scheduled, because I complained about the psychiatrist I saw last time, after he would not listen when I told him that this medication had side effects that I couldn’t tolerate. As a result, I’m in psychiatrist limbo.

My case manager is on holiday this week, so I was given another name to ask for if I needed anything. And I needed something. I need my brain back.

He told me that the psych that made me feel an inch tall was a good doctor, that he’s worked with for a long time. He told me that I could get in to see that doc on Monday. He said that if I didn’t want to see him that there was nothing he could do, and I could maybe try on Monday when my case manager gets back.

When I told him I felt trapped, because I was not going back to that psych and there were no other options, he told me I was not trapped because I could go to that psych. When I tried to tell him that I could not tolerate these meds any more, he told me that they were good meds. That because I wasn’t glued-to-the-couch depressed, they were working. That the doctor knew what he was doing when he put me on them. I felt like my complaints were trivial, compared to the depression I was feeling. That at least I wasn’t suicidal any more.

The truth is, I don’t feel the empty misery and suicidal thoughts. Instead, the problems I’m having are so debilitating that I’d rather die than carry on. Instead of passive wanting to die, I actively don’t want to keep living the way I am right not.

The options feel like they are: change the ‘way it is’, or change the ‘living’. But I’m struggling to find the support to change the way I’m living. All it takes is a doc to listen and try something new. Is that too much to ask?

Psychiatrists and the “I Know Best” Attitude, revisited

After speaking to the team leader of the psychiatrist I saw last week, I was feeling hopeful. After all, not every doc at Community Mental Health can be condescending and arrogant, right?

Not so fast. Apparently there is no way to swap me to another psychiatrist. No reasons were given, apart from “It’s quite tough at the moment”, but my educated guess is that every other psych is overloaded. I can’t be switched. The only suggestion is that the team leader could come with me to my appointments.

This is crushing. The very idea of willingly going back to a doctor that made me feel worthless, insignificant, and stupid, is incredibly upsetting. Having his boss sitting in may put him on his best behavior, but it won’t stop him being an arrogant ass.

I’m not very stable, and little things like this send me into floods of tears. I wish I could go back to the excellent psychiatrist as the crisis team, but he had to pass me on to Community because he’s not funded for long-term care. I feel trapped and powerless.

There are always personalities that just clash. His and mine are one such pair. The inflexibility of the community mental health team’s workloads means that I have to grit my teeth and feel beaten down by this man, or I can leave. It’s not good for me, and it’s not good for anyone else who finds themselves in this position. I just wish I knew a way to make this better for myself and everyone else that has to be treated by this system.

Psychiatry and the “I know best” attitude

Today I ran across one of the biggest problems I personally have with the mental health system – a doctor that has no respect for his patient. It was a crushing experience.

I don’t like being talked over. It’s one of those things that *really* bothers me. So when I am in tears before he who has the power, and I try to tell him that it’s because he keeps cutting across me, I hope for some sort of suggestion on how to work together so that I don’t feel ignored and disrespected. “I’m not cutting across you, and I have to, otherwise we’ll be here all day telling stories” is not calculated to engender co-operation. But he has the power, so I bite my tongue.

I don’t like being told that the starting doses of my meds are ‘nothing’. I’ve been on them all of five days, and I’m prone to side effects,so I titrate slowly to try and keep those side effects under control and let my body adjust. But you don’t know that, and so you tell me my treatment is not treatment. I feel dismissed.

When I ask a question about the medications you want to put me on, I am not challenging your knowledge or your authority. You don’t need to reel off your qualifications, and you don’t need to tell me that my “trying to treat myself” just complicates things. I’m not trying to treat myself. I only want to understand what your plans are, so I can understand what’s happening to me. You’re the expert, but I’m not stupid. I want to understand my own treatment.

I don’t want to feel patronised, insulted, talked down to, ignored, and disrespected. I’m trusting you with my body and my mind, and you can help me rebuild or you can break me. I deserve to be treated like an adult with a part to play in my own health, not like an errant child.

I always fear beginning over with a new mental health professional. This sort of thing is why. It’s far too common.