To find a lot of psychiatrists uncaring

[Sevendaysaweek]

Dn 19 has been admitted to a mental health hospital. I’ve found out today that she told her community consultant how low she was and that she felt at risk. He dismissed her feelings told her she had got through it before and that he was fond of her. Then told her she would see her worker the next week. The worker left suddenly and didn’t even tell dn she was leaving. I’m thinking to complain to pals as this could have been prevented and I feel so sad for her that it hasn’t been.

I’m sorry you have had a bad experience. Sometimes it is the person and sometimes it is the situation. Many of the other people the doctor saw that day would have been in similar situations and there are only a finite amount of medical staff and beds. Unfortunately community teams are stretched too and if anyone gets ill/leaves it can be difficult to plug a gap.

Do still write in to PALs. It could be a particular problem or it could help them improve. However do also be aware of how stretched the whole system is.

A psychiatrist is a medically trained Dr. The primary role is to make diagnoses and prescribe medication

There are few of us compared to the number of CPNs so we cannot see patients weekly or provide individual support in that way. That is the role of the care c/o usually a CPN

Some psychiatrists have additional training in psychotherapy but not your average general psychiatrist.

Psychologists are there to provide therapy
Social workers provide care packages
OTs help with functioning
Psychiatrists do medication

All workers need to have boundaries. We cannot be patients friends. That would be a harmful expectation to give. I would not tell a patient I was fond of them even if I was and I don't accept gifts. I care but in a professional way. Part of that is that appointments usually do have to end on time (because others are waiting) and I do not give out my mobile number to be called at any time. That just isn't the job.

The goal is for a person to be able to function without us not to create lifelong dependency

My DS has been helped a lot by his psychiatrist. He is like a different person since we started seeing her and he started in medication . He doesn't like her much but he doesn't really like any mental health professionals except one therapist he says he likes and says he will see and then usually refuses to engage when he gets there

DH and I find DSs psychiatrist very kind, empathetic and above all practical in her advice.

A friend who had spent a while in a mental hospital and remarked that the people you meet with egg on their tie, wrongly buttoned clothes and unbrushed hair may turn out to be the doctors which doesn’t inspire confidence!

The least caring person I've ever met was a psychiatrist. He was awful. The mental health nurse in charge of the business I worked for wasn't much better. I wonder whether they have to develop this hard exterior to deal with their training and their job. I didn't need to work in that world so left. It must be terrible to feel that you need support and that your needs are not being met.

I hope your daughter feels better soon and I hope someone is supporting you too.

@Fleurdelys1

A friend who had spent a while in a mental hospital and remarked that the people you meet with egg on their tie, wrongly buttoned clothes and unbrushed hair may turn out to be the doctors which doesn’t inspire confidence!

They do that on purpose to try and mix in with and spy on the patients.

A friend who had spent a while in a mental hospital and remarked that the people you meet with egg on their tie, wrongly buttoned clothes and unbrushed hair may turn out to be the doctors which doesn’t inspire confidence!

Doctors are still human!
Maybe they look dishevelled at times because they’re rushed off their feet, barely have time to eat, or got dressed in a rush because they had to get kids to pre-school by 7am so they could make it to work on time! Maybe they’re so busy seeing patients and completing paperwork they haven’t had a chance to look in the mirror!

I don’t see why unbrushed hair, buttons done up wrong etc would make someone question a doctor’s professional judgement?

Most wear scrubs since covid so a tie is rarely an issue? Scrubs look like pjs but I haven’t heard any patients complain about that.

A smartly dressed, perfectly groomed psychiatrist isn’t likely to be any better clinically than a dishevelled one?

DougRossIsTheBoss Thank you your replies have been helpful. Do you think I should complain about the fact he said he was fond of her? How regularly would you expect to see a patient as dn hardly sees hers?

No. You only have one word and no context. I am not sure why you blame the psychiatrist and no-one else. I think the only thing you should complain about is the fact the care c/o left without telling her and there was no replacement. That is bad and should not happen.

A psychiatrist doesn't generally have a close relationship with their patients and isn't the first person to call in a crisis. There are not enough of us to be first port of call for all our patients. It's the role of the care co-ordinator who is usually a mental health nurse or maybe an OT or social worker to be the first contact and the person checking in regularly. Eg weekly to monthly depending on need. It would be usual for a psychiatrist to only see a patient once every month or two if unwell for 30mins to an hour or 6 monthly if stable. If we saw people more often or for longer then we'd see less people as there are only so many hrs in a day. Also Drs are expensive to employ vs other hcps.

I usually see outpatients once to diagnose and make a treatment plan and then I hand on to the care co to monitor and support and they feed back to me. This is usual practice. If medication specifically needs to be reviewed then there might be an appt every month to 2 months until stabilised.
Inpatients of course I see more often at least weekly and crisis patients somewhere in between but on the whole I have to work through others. There is 1 psychiatrist in our team but at least 6 nurses (think it should be 8 but posts are unfilled) and 4 team support workers so you can see that each patient cannot have 1:1 with the psychiatrist all the time.

I'm bloody loving the coronavirus scrubs and hope they stay.
I'm sick of being judged on my appearance especially as a woman. So many people feel entitled to comment on my shoes, clothes, make up (or lack of it in my case) skin, weight, age and general attractiveness and I hate it.
What the hell relevance is that to my ability to do my job as long as I am tidy and decent.
Some people feel threatened if you are 'too smart' and others criticise you for being too casual. In general it's one you can't win and I wish we had a uniform.

Over the years I have experienced one genuine arsehole of a phsychiatrist, the rest have been amazing.

However, at the time near enough everyone involved in my care were uncaring, unprofessional, need the sack bastards. It's afterwards I realise that aside from that particular one, they were fab and did what they needed to do to treat me.

Obviously I realise I have been incredibly lucky, and this isn't always the case. Unfortunately there are those who do slip through the gap, and this isn't inclusive to psych services.

The Pals involvement, without her say so there's nothing you can personally do.
During normal times, there's usually a wait of at least 6 weeks. At the moment getting someone assigned is much longer.

If she hasn't got one, suggest she gets an advocate. When she was admitted she should have been given all these details.

I've also had people "walk out on me" and never returned.
What I failed to mention was I told them to fuck off and never come back, and how it's worded can be incredibly threatening. If the relationship has deteriorated that much it's in neither of our interests to work together anymore.
And more importantly, why should that worker have to continue working with someone who is volatile towards them?

DougRossIsTheBoss That’s the problem she’s got no worker so I would have thought the psychiatrist might see her more. Does the care coordinator update you on all your patients regularly?

Yes. That's how it works. Care c/o sees and reports back to psychiatrist.
If a person is very stable and capable they might not have another worker and would just get seen in OPC every few months but they have to be able to manage with that level of contact. If they need more they get referred for a care c/o. I can't just magic up more time to see people if they run into a crisis or
if their worker leaves. I am already fully booked up with my current patients.
The worker should be replaced or their role covered or if they didn't have one and run into a crisis then we would refer to crisis team. Usually people can self refer to a crisis service or at least call an emergency number. I'm sure all services would have a 'duty worker' system for that kind of emergency. It would not be the job of the psychiatrist to fill in.
Obviously I am not heartless and if one of my patients does call in a crisis I will try to call them back as soon as I can and arrange something suitable for them but it would very likely not be a visit from me or an extra appt as I have no slack in the system for that.

Also if I am on holiday or off sick then I can't call back so that's why we have emergency numbers and duty systems that are always staffed to avoid dependence on one person who might just not be there through no fault of their own.

If people want one on one personal frequent contact with a psychiatrist then they would need to pay privately for that but I don't do private work because I don't agree that that way of working is actually a good thing. I think a team approach is best. Fairly often I get phoned up by private psychs because the patient needs more than they can give or runs out of money so NHS does mop up private failures like in all specialties.

Here is you have been out of the mh services for 12 weeks, to get back to the crisis team if you can, you contact your gp or go a&e.
If within 12 weeks, you can self refer straight back to crisis. I thought this was standard practice in the UK?

When I've been in crisis, the involvement from the psychiatrist has varied depending on what I was there for. Anything from every 3 days to weekly. Although a team is what they try and aim for, this understandably isn't always doable.

@DougRossIsTheBoss

Yep bunch of uncaring, unempathic clock watching bastards the lot of us.

Never done a seconds overtime or thought of a patient outside work in our lives.

Never shed a tear for any of them
Never lost a wink of sleep worrying about them

I mean mental health is the ideal career choice if you don't give a shit about people right? Stupid buggers never thought of pathology.

Or could it be that
A) he made a mistake in risk assessment due to being a human
Or
B) that admitting every patient who asks for it is not a logistical possibility or even a good idea and reminding someone of times they've got through before is giving them hope and encouraging coping strategies which might be better in the long run than admission...

Nope couldn't be that 'cos all psychiatrists are uncaring hopeless bastards.

Im with you....im a CPN. I've been in nursing since 1986, and in those years, services have been cut, cut again, then cut even more. The pandemic will only make it worse. I do honestly really care for the patients but hate the job, because I'm fed up with hearing patients bare their soul, only for me not to able to offer them anything becausetheres nothing I can offer.

Blame the system, blame the Tory government, but don't blame us who are working in it. We're not in it for the money or prestige, because trust me, there's neither in mental health care.

The fond of comment was apparently made in the context of don’t do anything harmful we are fond of you. I would assume psychiatrist don’t tend to either like or dislike their patients as this would be unprofessional surely?

Too much is being read into using the word fond.

Although not sure how they can be classed as uncaring, yet use caring language.

I was just shocked he used that word.

He might have just got fed up with using the word like at the time and was mixing it up.
The specific word could have also been chosen because it fit in with whatever was going on at the time. If it's a word she uses herself a lot, ime, mh workers also use words we seem to like. It's all about the context.

They can't win, can they?

One minute they don't care enough, then they care too much and it's unprofessional?

What would you like from them? Maybe if you start there we can advise you as to whether or not that would be usual/possible/likely. It's much better to approach these things with realistic expectations if you're unfamiliar with the system. As people have already outlined, often what patients and their families expect to happen is very different from the reality, but this isn't usually because people don't care

@nc1962 Someone should be sectioned if they're begging for it? No. Someone is only sectioned if they are a danger to themselves or others and not being treated would be of detriment to them and they are unwilling to accept help/go into hospital. If someone is "begging to be sectioned" then they don't need to be. They will come into hospital and be treated informally.

The general public have a massively high (and quite frankly unrealistic) expectation with what psychiatry can and can't do. A psychiatrist can't just section people willy nilly, there are laws (the MHA) to follow and each action needs to be justified and proportionate.

The problem with mental health services these days are yes, lack of funding but also huge misuse and abuse of mental health services. Where I used to work, a 20 bedded unit, I'd say only about 6 or 7 of those people needed to be in hospital. Less than 50% of them had genuine mental illness. We are seeing more and more people coming in with normal life stressors being self diagnosed as 'depression', 'anxiety' etc and demanding therapies etc ie a magic wand to make everything better.. However psychiatry cannot do anything with issues such as situational stressors. And many people do have quite frankly shit lives due to poverty, lack of social support, relationship breakups, lack of a meaningful life etc. Psychiatry is there to treat and manage mental illness, not to fix the aforementioned problems. It just can't.

The majority of the people I've met who are genuinely, chronically mentally unwell would do anything to get out of hospital or not be admitted in the first place. They are so ill that they don't understand or appreciate why they need to be in hospital.

I'm sorry to hear of your sisters struggles and I genuinely hope she's in a better place now.

@Sevendaysaweek I'd be surprised if there wasn't a bit more of a backstory. If there is a diagnosis of EUPD (you say there isn't but there are other posters contradicting that based off other posts of yours so I don't know) then perhaps the conversation went something along the lines of your DN getting upset and stating that no one cared about her due to her not getting the support that she wanted. And the psychiatrist responding that that wasn't true at all and there are many people who are fond of her/the team are fond of her/he is fond of her. And then the conversation has been mis-reported back to yourself. Kind of like the 'I hate you, don't leave me' narrative that we often get from people with EUPD.

If your DN does have a diagnosis of EUPD then often it's not in the patients best interests to be admitted to hospital. Often problems become worse while in hospital and maladaptive behaviours are learnt from other patients. Many trusts are piloting 'PD Pathways' as a way to stop admissions for people with a diagnosed PD and form other clinical routes ie community support, group therapy work etc.

[quote AwaAnBileYerHeid]**@nc1962* Someone should be sectioned if they're begging for it? No. Someone is only sectioned if they are a danger to themselves or others and not being treated would be of detriment to them and* they are unwilling to accept help/go into hospital. If someone is "begging to be sectioned" then they don't need to be. They will come into hospital and be treated informally.

The general public have a massively high (and quite frankly unrealistic) expectation with what psychiatry can and can't do. A psychiatrist can't just section people willy nilly, there are laws (the MHA) to follow and each action needs to be justified and proportionate.

The problem with mental health services these days are yes, lack of funding but also huge misuse and abuse of mental health services. Where I used to work, a 20 bedded unit, I'd say only about 6 or 7 of those people needed to be in hospital. Less than 50% of them had genuine mental illness. We are seeing more and more people coming in with normal life stressors being self diagnosed as 'depression', 'anxiety' etc and demanding therapies etc ie a magic wand to make everything better.. However psychiatry cannot do anything with issues such as situational stressors. And many people do have quite frankly shit lives due to poverty, lack of social support, relationship breakups, lack of a meaningful life etc. Psychiatry is there to treat and manage mental illness, not to fix the aforementioned problems. It just can't.

The majority of the people I've met who are genuinely, chronically mentally unwell would do anything to get out of hospital or not be admitted in the first place. They are so ill that they don't understand or appreciate why they need to be in hospital.

I'm sorry to hear of your sisters struggles and I genuinely hope she's in a better place now.[/quote]
Yes. All of this comment. All of it.

PlanDeRecordament "They do that on purpose to try to mix in with and soy on the patients."

You meant this lightheartedly I presume.
As an inpatient I deludedly believed just that (and still believed it a month after discharge )