Hey fine folks, feel free to ask me anything regarding the NSW Mental Health Act (2007) and what to expect if you, a loved one, or a friend are *scheduled by police, ambulance officers, or mental health professional. Please keep in mind that I am unable to comment on your personal experiences, the suitability of the medications you have been prescribed, or your diagnosis.
*Scheduled - detained as an involuntary patient under the NSW Mental Health Act (2007)
Easiest way to get out? Ask for some "leave" / go for a cigarette and walk off, don't come back.
Unless they can schedule you - you can leave as you please and they probably won't care either that you are gone - you have just freed up a bed that they need.
True.
Once you are in you have to have people on the outside to fight for your release.
That is very hard and very difficult because there is no honesty whatsoever in the mental health system. it usually takes well over 4-6 complaints about anyone working inside it to get any investigation into whatever its about, theft, sexual assault, striking patients etc. yeah its such a great system - assuming that they are even logged of course…
You'll find the court cases buried in your press in little boxes, and of course the guilty nurses and staff are sometimes not even struck off even though found guilty. They just move State. Like busting up the faces of your granny in old peoples homes, the mentally ill are frequently the objects of systematic abuse by mental health unit staff. There is no doubt that some staff work in these places for the opportunities that are presented - zero screening.
Sane response to an abusive and completely inhumane and degrading system. What they learnt is what everyone should know - its an unregulated abusive system that destroys people for undeclared reasons. Shame they had to learn the hard way.
Not sure if it's been asked already. But roughly how much do you earn? Do you feel you are being compensated appropriately and do you get other perks (extra annual leave, mental health days etc?)
I made about 100k last year (with a little overtime)
I didn't fully address your questions in my previous reply. Nurses are poorly paid. 100k sounds like a decent wage but we work a 24 hour rotating roster and if it wasn't for penalty rates we wouldn't earn a decent wage. A registered nurse starts at 'Grade 1' [first year on the job], and we get a pay rise each year until Grade 8. The pay rise each year is about $60 a fortnight. A perk of working a 24 hour rotating roster is we get 6 weeks annual leave each year and an ADO each month. We don't get mental health days, just 11 sick days a year. If you like hospital food, that could be considered a perk. It's not, trust me.
I am also studying nursing (3rd year), however the pay is abit off putting as a graduate nurse in Victoria only earns $27 an hour working 0.8 a fortnight. I understand the fact we are still new nurses and learning but I could we working as a disability support worker and earning $33/hr + without any qualification. I am also looking into a psych nurses vs general nursing.
Whats diff between Psychiatric & Psychologist?
one for certified crazies, one for anxious/depressed people - not quite 'mental'
the latter will refer you to the former where required.
Psychiatrists are doctors who have specialised in mental health. They can prescribe and deliver biological (medications, ECT) and psychological treatments. Clinical psychologists usually have at least a masters level degree in psychology and do a couple of years doing clinical training. They specialise in psychological therapy.
I used to wonder that. Now i reckon i have a pretty good idea. I'll break it down into education and what they do.
psychiatrists have all gone to medical school and are knowledgable in all fields of medicine but have specialised in mental disorders. They need to have gone to medical school because when they prescribe an anti-psychotic, they have to understand that it may cause prolactinemia and all the rest of the brain chemistry and physiology. Psychiatrists do psychotherapy and the arm chair stuff as well. They deal with the most severe of mental disorders. Think suicide, psychosis and all that.
Psychologists (i assume clinical) do a bachelor of psychology then a masters or pHD in clinical psychology. they don't prescribe drugs and deal with mental disorders less severe and generally are the ones giving CBT (talk therapy).
eg:
If you had some vague sense of anxiety, you'd go to a GP who will refer you to a psychologist. If you feel suicidal then your GP will refer you to hospital. You will then see a psychiatrist who may diagnose you with xyz then medicate you then set you up with a psychologist for talk therapy, a social worker for income support and whatever.
Adding to the above points, psychiatry is mainly about helping those with mental health problems. While psychologists can be involved in mental health problems too, there are many types of psychologists and some are involved in lifting mental health above and beyond the level of normal. For example, school psychologists may work with teachers to improve the school culture and environment by actioning from positive psychology research.
I’m a healthcare student starting on a mental health rotation in the coming weeks. I’ve not had much experience with inpatient mental health before and so, don’t really know what to expect. Do you have any tips to help a student get the most out of their rotation?
Thanks!
I'm not sure what a "healthcare student" is. Are you studying nursing?
Sorry about being vague haha, I'm currently studying medicine.
Any tips would be helpful though! It's a different environment to what I'm used to :)
From my experience, med students don't spend all that much time on the unit other than to sit in on patient reviews. You'll be buddied up with a psych-reg and consultant who'll likely task you with writing the notes in the patient reviews at some stage. So arrive with a working knowledge of mental state examinations. And talk to the nurses because we have a far better all round knowledge of the wards and the patients. ;)
The nurses will tell you who the interesting patients are and which patients will be open to chatting one on one with you. And wear a duress alarm at all times if you enter the ward. Good luck.
if you work in ED and you're lucky the consultant will let you interview the ED patients, do a full history, mental state exam and report back to them with your provisional assessment and plan. If you don't work in the ED then just watch the doctor work and chill :)
if you're taking a history, you have to be a bit more sensitive than when interviewing a medical pt with chest pain. everyone who comes in is either suicidal or psychotic. both are challenging to interview. psychotic is hard for obvious reasons. suicidal is hard because there's usually some stressor that's difficult to talk about. child sexual abuse is more common than you might expect and obviously it's good to be tactful and flexible when enquiring about suicidal ideation.
Golden tip is to ask about the soft stuff first: "who do you live with?" "are you currently working?". But you're here to figure out why they're presenting, so you'll eventually going to have to ask them why they're in hospital. Hopefully you've read the ED notes before hand so you know that they just ingested x mg of y drug to overdose so you can get some sense of if they're forthcoming or not.
Note: suicidality is important because it determines whether they are admitted or not! don't forget to find out.
If the flavour you're getting is that they're here becasue of a recent stressful event (which is frequently is), ask about their mood to get an idea of their suicidal thinking. "It's been shit doctor…" follow that up with "when people feel really down, sometimes they feel like life isnt' worth living… do you ever feel like that?" Now they'll tell you whether they are suicidal or not, and you've made your opening to further explore their suicidal thoughts.
For suicidal presentations: #1 is adjustment disorder. if self-harm is involved, consider borderline personality disorder (almost always, as BPD by definition includes traits of suicide/self-harm). If there are flashbacks/triggering consider complex PTSD, but note that people don't kill themselves directly because of PTSD. There's usually some underlying depression or borderline. Substances hx important; alcohol increases impulsivity etc
For psychotic presentations: Rule out medical causes ie delirium. most common psychotic presentation is drug induced psychosis, which is not a primary psychotic disorder. therefore substance history important. Make sure to get an idea of hallucinations and delusions as well as how they correspond to their drug use. Are they visual/ auditory/ olfactory? Do they know it's not real? Are they also delusional? If they aren't using any drugs then it's going to be somethign like shizophrenia/shizoaffective/shizophreniform/brief psychotic disorder but the psychiatrist can handle it at that point.
@D0NALDTRUMP: This is fantastic, thanks so much for all the advice! I’ll do my best to remembe all of it when I start.
@etns: I wrote that up in the early hours of the morning… there is something else that's useful for psych reports back to the consultant. Instead of ISBAR, use IBSAR, put the background in front of the situation. eg:
Jane is a 20 yo F who she lives with her partner in a rental housing and works as an accountant. (Now give the background, as you have to establish the context of the situation) she has a background of depression, borderline PD and a restricted eating disorder. She attends CBT regularly with her psychologist and sees GP Dr Bob for her medication of xyz. He is known to the community mental health team.
Jane presented to the ED last night after OD polypharmacy of xyz. Prior to this, her boyfriend insulted her and invalidated her. She reports that the OD was to help her numb/cope and forget what he said and not necessarily to kill herself. She denies currently suicidal ideation.
IBSAR
@D0NALDTRUMP: It's weird because in the rest of medicine it's more of a RISBAR
Hi Dr Trump I'm calling about this 20 year old girl in the ED who I think might be able to go home. Her name is Jane, she's come in voluntarily following a polypharamcy overdose in the context of an interpersonal conflict with her boyfriend. She's got a background d of depression on xyz, borderline PD and a restricted eating disorder managed by her GP, psychologist and the community team.
She's been medically cleared from her overdose perspective by ED, and she denies any suicidal intent or any ongoing suicidal ideation. I don't think there are any clear risk issues and she wants to go home.
Are you happy for me to send her home with community follow up or do you want to look after her for a few days in PECC?
Hi OP. Thanks for doing this AMA and bring awareness to Mental Health.
My cousin was diagnosed with Bipolar Disorder 6 years ago. Was in the psych ward and eventually discharged to a GP. Still taking same meds that the Psychiatrist at the hospital prescribed.
Even if he's been well, is it recommended that he sees a psychiatrist To review his medication? If so, how often?
he has some side effects and has asked the GP to change the medication, GP refuses and preferred to give new medicine for those side effects. He has had those side effects for years but until now willing to do something about it.
Thanks!
Thanks for your question but unfortunately I can't offer advice on personal experiences or the medications people have been prescribed. GP's have very little mental health training so they are usually reluctant to tinker with a medication regime prescribed by a psychiatrist.
Thanks for your insight!
You're welcome. Personally, if I was experiencing side effects from a psychiatric medication and I was not in regular contact with a private psychiatrist, I would call my local Community Mental Health Center and make and appointment to see a psychiatrist there to discuss my concerns.
What's the side effect?
Many people reading this thread are probably shaking their heads at the stories and wondering how someone could believe they are the new messiah, or that the government has put listening devices in their walls to spy on them. The problem with many people experiencing delusions is that they believe they're right and everyone else is wrong. What's more, the person with the delusion believes they are the sane one who has 'woken up' and therefore don't need medication. It's an extremely frustrating illness to treat when the person who has the illness doesn't believe they are ill.
It sometimes frustrates me that the people with a mental health condition interviewed on TV or radio about their experiences are the ones who realise they have a problem and thus seek treatment. There are a whole lot of people out there with schizophrenia who actively resist treatment. I know someone like this and it's extremely frustrating and sad to watch. It can literally tear a family apart.
what you earning a in a senior nursing role these days per hour?
$42 per hour plus penalty rates.
Solid - good job and getting to a senior level :)
Thank you for doing a job that I would not be able to keep doing (might survive a day or a week in there, but longer… no). And this leads me to this question… how do you keep your sanity? How do you keep this job from getting to you too much?
If Jesus or Mohammed lived and preached in NSW today, what are the chances of them not being scheduled under the MH act?
less than.00000
Being psychotic or manic isn't enough to be scheduled under the mental health act. You have to demonstrate that there is significant risk to self or others and that an involuntary admission is the only way to mitigate these risks.
There are plenty Jesuses out there in the community, minding their own business.
Correct.
A person could be homeless, wearing the same soiled clothes for the last six months without ever changing, likely never had a shower, with double incontinent, with sores/scabs all over their body but because they just sit in an stairwell emergency exit and never bother anyone - if there is an assertive outreach team that visits them, they might say "I am OK, don't need any help" and that's it. That person will never get the right help that need.
I'm Spartacus!
most psychiatric drugs do little to cure anything as medical studies show.
the same goes for ect - many patients report improvements in their condition solely due to trying to avoid being shocked again.
Psychiatrists produce few good outcomes at incredible expense dispensing drugs that are routinely associated with causing severe long term fatal conditions as demonstrated in many studies.
in fact many drugs used in treating mental illness routinely produce death by suicide in the short term.
the western model is in many countries being altered to support and help people with mental illness in their own homes, and because the drug companies and psychiatrists are not so involved they are in fact cheaper and produce in many cases better outcomes.
You ain't never gonna hear it because psychiatry is deeply involved in military studies and drug trials, and has been for decades, and the mentally ill today like in nazi Germany are of no consequence to the majority.
Its a very lucrative business for those involved, and if anyone in it breaks ranks, they get broken, ridiculed and destroyed.
Reckon that fact alone reveals much about what's really behind the current treatment model.
many unfounded comments here mate.
like which ones?
the ones that you don't have sources for.
@petry: The onus is on you to source your evidence, not on others to prove why you are incorrect.
Large sweeping comments like yours with no sources tend to be unfounded. Happy to be proven wrong, but they sound very similar to "Can't trust those vaccines, they cause problems in kids that the industry tries to hide." Completely wrong and unfounded, but can cause a lot of harm if others don't check you on it and ask for some evidence.
@DingoBilly: really? I asked for evidence from the person asserting that they were somehow blessed with absolute medical knowledge and merely got a snide arrogant response which is what you would expect from someone in this industry ie 'the ones that you don't have sources for'.
psychiatry is the branch of medicine absolutely embedded in devising torture technigues breaking most conventions, and these doctors make an absolute mockery of the fictional notion that doctors should do no harm.
whether you're trolling or not I really don't care -people should read up about psychiatry and torture techniques and make up their own minds. they should note the professional associations have done nothing to disqualify them from membership or practice. Maybe you should stick to tv shows about how great doctors are…. and the hippo-cratic oath - the biggest lie still doing the rounds.
Please, tell us how someone suffering from schizophrenia (who doesn't believe they are ill: anosognosia) should be treated. People have tried natural remedies, herbs and spices for many hundreds of years yet no one has come close to an effective treatment. Psychiatric drugs are a bit of a sledgehammer to the problem and often produce a plethora of side effects, but they keep the patient in check and able to lead somewhat of a normal life.
Please inform us how you go about treating someone with schizophrenia who is absolutely sure of their delusion and is on the verge of harming themselves because of imaginary problems. You cannot just talk someone out of their delusion no matter how hard you try.
I thought nowadays cognitive therapies are used by clinicians to encourage the formation of coping strategies, living strategies and general getting-by strategies.
One would think that a chemical inbalance in the brain would need to be addressed first to increase the effectiveness of such therapies.
The chemical imbalance is a myth promoted by companies selling very costly drug treatments. Its the snakeoil of psychiatry.
overheating is a more useful concept and encouraging cooling off by calming sedation and diversion strategies a more healthy and long term form of treatment for many.
relaxation helps many so called well people - but when its impossible to calm yourself because your brain is so overheated you are in trouble and need help. Many get ill simply because they can no longer sleep properly - apnia for example can cause psychosis, as do drugs and alcohol abuse. Bizarrely helping people to sleep properly is not a primary form of medical treatment despite numerous studies proving the economic benefits to a nation.
Instead we have a plethora of very expensive and powerful drugs of an unproven long term nature being readily prescribed by the snakeoil merchants fronting big pharma - and they are extremely well paid.
Overheating and cooling off look to be simplistic notions.
I believe many medications given have a sedative effect too.
@Eeples: brain scans of many mentally ill people shows intense activity that does not readily subside hence the term overheating.
what causes it to do this and not to slow down easily is associated with stressors.
many medications are experimental to say the least, and have no known curative effect aside from the fatal conditions they frequently induce further down the line.
The sedative effect is arguably the selling point of the grotesquely expensive drugs used, because they do at least do that.
However simple sedation can be achieved far more cheaply and is arguably at least as effective in many cases.
If you prefer snake oil that's your choice but I suggest you look up the definitive explanation of brain chemistry and its control because there isn't any. Changing something you don't understand is guess work and experimentation hence we live in a world where mental patients are test subjects, and that sadly is a fact.
@chuckles89: you'll need access to medical libraries, and since the medical people here won't post any I won't be posting any either.
You can access torture stuff relatively easily, but fiddling with brain chemistry is just guesswork. every year or so someone comes up with a 'better understanding'. that began with drilling holes in skulls…in bedlam… nothing much has changed really
this is exactly right. Hit em' with both talk therapy and anti-depressants
I always find the room that you can't hurt or kill yourself no matter what you try is amazing. Can there be public tour to try to live inside for a day?
you mean like visit the zoo?
Q1. Roughly how many patients per year would receive electroshock therapy where you work? In your opinion how many are better off and worse off after it.
Q2. I am guessing cigarettes are banned for patients? Is a blind eye turned to patients smoking?
Q3. Would you say that patients frequently make friends inside and do you know anecdotally if those relationships generally persist afterwards?
Thanks.
Thanks for your answer.
Regarding Q1…. can you quantify it all…. 1 or 2 a year or twenty or thirty a year?
Thanks.
Great AMA as @Shenanigan clearly knows their stuff.
This is what i find curious about OB - one moment you're reading crap, but if you hang around long enough you'll hit something like this.
I might make a few random comments about what i know of the criminal justice system (CJS).
People with a mental health problem are overrepresented in the CJS. Around 22% general population has a mental health condition, but this jumps to about 77% for prison inmates.
Those with mental health disorders are overrepresented in CJS as (a) Disproportionate policing (especially indigenous) with the exercise of police discretion & homelessness, (b) Less able to contest charges given lack of knowledge of legal services available, how the CJS operates and less able to understand court processes, (c) Less likely to get away with the crime.
Jump is partly due to prison system exacerbating or creating mental health disorders, but also those with mental health issues are more likely to be found guilty & given custodial sentence.
Substance & alcohol abuse is the number one factor that impacts on whether a person with a mental health problem comes into contact with the CJS.
Incarceration is likely to exacerbate their condition and putting them through the CJS is unlikely to achieve any great benefits. This is as a person with a serious mental health condition is unlikely to be deterred from reoffending by being sent to prison - they are more likely to be deterred from reoffending if they receive adequate treatment & support in some kind of public health facility.
How do I reach out to someone who might be having a hard time? i.e. experiencing suicidal thoughts or going through a depressive episode?
Is it common to have a patient admitted following a psychedelic-induced psychosis or similar?
How do you personally feel about psychedelics? Have you tried any?
all the time. drugs can permanently make you psychotic
Is it like the movies in the Psychiatric ward where people scream at night, bash their heads on the (padded) wall etc?
Have you ever been physically attacked?
I was once told that admission to these sorts of wards can limit where you are allowed to travel. This was in relation to suicide in particular, but was told it then could mean being banned travel to countries where people go to arrange it in other ways.
Actually made me not go in when I needed to due to worrying about it going on my record as such, but wanted to ask if this is actually true or not. Might have been people just fearmongering to stop me from going in.
Depends on the country and highly likely it will not affect your travels. BUT even Australia has questions regarding mental health, admissions etc regarding visa entry. In saying that they, especially other countries, would have very little on the way to check records as it should very well be private.
like the new patient record scheme with its extensive access private do you mean?
How do you feel about the breakfast/lunch/dinner services in the MH units?
In your opinion, what is the best antidepressant? And the worse?
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Patients on antidepressants and psychiatric medications are usually at greatest risk (increased risk of suicide/other adverse events etc) during the first few weeks of new medication. I think in the long run this could have been the best situation for this family.