Email | Print

Let’s face it, psychiatrists have a pretty difficult job. Are you prepared to tell someone that you may never have met before your entire life history and all of the private and possibly disturbing thoughts that you have? Plus, there are no blood tests or urine samples to produce an accurate diagnosis and guide the doctor with his/her choice of medication or treatment.

The keys to psychiatry, I believe, are communication and trust with both these factors being difficult to develop when the patient and the psychiatrist only see each other around once every two months. This time lapse is no one’s fault—it is just the way that “the system” operates and, unfortunately, it sets up even more barriers than were there already. As a service user myself I have often found myself in the waiting room with a myriad of thoughts and feelings spinning round my brain saved up from my last session with my psychiatrist only to enter his office and discover that my mind had gone blank. The lesson I learned from that experience was to write everything down so that if I did freeze I had something to refer to. Writing things down can really be of help to both the service user and the psychiatrist. I know of one service user who was so unwell she could not even speak about how she felt, so I suggested jotting down her feelings and thoughts and handing the list to her psychiatrist. He commented he learned more from that action than he had in all the years that he had been seeing her previously!

One thing that a lot of people have strong emotions about is the ‘D’ word—Diagnosis. Some people, like myself, are desperate to hear what their diagnosis is so that they can begin to proactively deal with their illness. Others are frightened of the label that a diagnosis can bring and would rather their condition go unnamed. I spoke to a psychiatrist, Dr Z, to ask him how long it takes, on average, before a diagnosis is made and the patient told? He replied that asking a question like that was akin to asking how long is a piece of string and that the selection of a diagnosis is much more complicated and subtle than that. He explained that a diagnosis is more of a formulation of symptoms which can be different for each individual. I have a diagnosis of bipolar affective disorder (2) but my symptoms differ in many ways to my friend’s. Imagine how hard it must be to come up with an idea of what medication, if any, will be effective in combating those symptoms. It took a long time for a suitable regime of meds to be found that would get me well and suit me physically as well as mentally. After lots of serious problems with meds a combination that suited me better was found. I am comfortable about my medications but appreciate that the majority are not.

Once an effective treatment with the minimum of side effects is reached it is up to the service user to persevere with the treatment if they feel that is right for them. If it is not they must be able to try alternative options. That must be their right.

I think it is fairly reasonable to assume that if one is being sent to see a psychiatrist then all is not well. A huge stumbling block that can occur is that you simply don’t like him/her as a person and as such find it extremely difficult to be open and forthcoming about what is going on in your life. It is important to remember that you can always ask to see someone else; however this may cause a delay as you are waiting for a new appointment. Another thing to remember is that the psychiatrist may not like you! This may be hard for you to imagine, but psychiatrists are only human too so whilst they should always be professional and do their job, they can’t realistically like everyone who steps into their office!

I appreciate that going to see a psychiatrist for the first time can be a very daunting, even scary prospect and that a lot of people aren’t interested in developing a good working relationship with their doctor—they just want to get better as soon as possible and hopefully never set eyes on their psychiatrist again! But for those of us who have a long-term association with the psychiatric services, it can only be of good to the patient for the relationship with their psychiatrist to be transparent and positive.

One of the difficulties in being a patient in a psychiatric hospital or ward is the lack of continuity of care. From personal experience on admission you may see one doctor, the duty psychiatrist, who may be someone you have never set eyes on before. All this leads to confusion and a feeling of instability in the already bewildered mind of the patients. Whilst I can appreciate that it is unrealistic for your usual psychiatrist to be present at your admission, I still don’t think the staff realise how difficult it is to disclose often very personal, frightening thoughts and feelings to a person that you have never met before. I wish there was a solution for this problem.

The professionals should not be THE ENEMY. They should be there to help and provide you with the appropriate care/treatment and above all, someone to listen with an open mind that will not judge or condemn regardless of what you disclose. Contrary to what many claim, the majority of mental health professionals are not trying to make our lives harder—yes, they are human and can get it wrong. Yes, they can get complacent about what they are doing and forget the effects on patients.

Perhaps we as service-users should be reminded that staff are frequently doing a hard job in trying circumstances, sometimes making difficult decisions that they have to live with on their conscience too.

My experiences of mental health care have been hugely positive and whilst I have been through times I wouldn’t wish on a worst enemy, I believe that it is due to the care and treatment which I have received from clinicians that I am here today. The psychiatrist that saw me through my hospital admissions time was a cracking guy. He saw me ‘Suzy Johnston’ and not just the patient. A very understanding man who let this ‘patient’ go and play a ‘gig’ with her band while she was an inpatient as he recognised that she needed to do it.

I continue to see my current psychiatrist on a regular basis and, though we got off to a rocky start as we misread each other’s character initially, we both persevered and now have a good working relationship with mutual respect.

Good psychiatric care is possible—I have benefited from it, so hopefully others will continue to learn from such experiences.