Dear Sir,
I have just completed a three-year tour of duty across Australia working as a locum consultant psychiatrist. At my last position, I worked as a consultant on the psychiatric ward at a leading state hospital. I walked out when I was victimised by the ward staff for opposing the repeated seclusion and neuroleptisation of a so-called borderline patient.
The last straw was when I refused to support an application to State Trustees for the patient’s financial management. The patient had repeatedly acted out on the ward, smoking in her room, tearing patient information sheets off walls, and periodically overdosing on Quetiapine. She had a propensity to spend her Centrelink cash on new clothes, and so never had funds for accommodation. It was decided by the ward staff that her housing problem could be relieved by taking away her responsibility for her finances.
Code-black, physical restraint, and neuroleptisation, were the rule. Any attempt to introduce a dynamic formulation of the patient, and implement appropriate dynamic therapeutic strategies, was met, not merely with derision, but with active opposition. I could cite such experience at more than a dozen different locations where such bullying approaches are routinely substituted for care informed by nuanced, phenomenological, and dynamic models.
Those working in the public psychiatric institution have long abandoned any such nuanced approach. Management is now based on categorical diagnosis a-la-DSM/ICD, neuroleptisation and restraint. Of late, an epidemic of amphetamine abuse, and drug-induced psychoses, has placed pressure on public psychiatric systems. In the absence of stand-alone mental facilities, acute psychiatric wards centre on the management of these and the revolving door patient. Rehabilitation wards house the new, psychiatric long stay. Community psychiatry relies on non-psychiatrists, and as NGOs take it over, services increasingly rely on non-psychiatrically trained carers.
The deterioration in public psychiatry was noted 25 years ago. In the 1990s, I supervised the publication of Menders of the Mind, the institutional history of our College. [1]
The authors, Bill and Hilary Rubinstein devoted a chapter to Chelmsford and Townsville. They noted that these ‘scandals’ occurred in the context of deinstitutionalisation of the mentally ill. More significantly, they noted that “If the College has had any perceptible bias … it has been in the direction of responding more vigorously to the interests of Australasian psychiatrists in the private sector, while neglecting the residual public sector, including the standards of institutionalisation provided in public mental hospitals.” Has anything changed since that statement was made? If anything, the situation has considerably worsened. Then, psychiatrists were the main professional bully’s. Today, it is systematically empowered nurses and paramedical and non-medical staff. [2] [3] [4]
Between the 1960s and 1990s, considerable interest was shown by our Fellows in abuses in psychiatry, overseas, particularly in the USSR. [5] Little interest was shown in local abuses. Instead, legalisation of psychiatry was substituted for humanisation. Draconian Mental Health Acts across the states paradoxically dehumanised and restricted patients rather than freeing them. Instead of receiving social justice, patients continue to “rot with their rights on.” [6] Local psychiatrists uphold this system of psychiatric oppression through their participation in, mental health tribunals.
Public psychiatric services are deteriorating, but there still does not appear to be a movement in our College to acknowledge the problem, let alone seek to reverse it. The obsession is with the quasi-medical, legal and administrative (bureaucratic) dimension of mental illness. The time is ripe for change. Bell-ringers never succeed. A College of committed Fellows might just ring the changes. They could start with an audit of public psychiatry. Meantime, Cuckoo’s Nest thrives.
References …
1. Rubinstein WD, Rubinstein HL. Menders of the Mind: a history of the Royal Australian and New Zealand College of Psychiatrists, 1946-1996. Oxford & New York: Oxford Universities Press, 1996.
2. Hagan K. Nurse quit, appalled by abuse of patients. The Age, September 5, 2011. www.theage.com.au.
3. Edwards K. Inside a psychiatric ward. http://www.smh.com.au/lifestyle/health-and-wellbeing/wellbeing/inside-a-psychiatric-ward-20130227-2f5id.html
4. Mackenzie B. Lismore mental health nurses found guilty of misconduct by health complaints commission. ABC North Coast, 13 Apr 2017. http://www.abc.net.au/news/2017-04-12/lismore-mental-health-nurses-found-guilty-of-misconduct/8439950.
5. Bloch, S, Reddaway P. Russia’s political hospitals: the abuse of psychiatry in the Soviet Union. London: Victor Gollancz Ltd, 1977.
6. Kress K. Rotting with their rights on: why the criteria for ending commitment or restraint of liberty need not be the same as the criteria for initiating commitment or restraint of liberty, and how the restraint may sometimes justifiably continue after its prerequisites are no longer satisfied. Behav Sci Law, 2006; 24: 573-98.
*Anonymous Doctor is known to the Kevin Moylan: Extract here
EARLIER on Tasmanian Times …
