It’s 3am and I have a patient. He was found on the street, sleeping rough, and the police could not make sense of his words.
After a brief trip to the hospital it was decided that he was ‘mentally unwell’ and now he stands in front of me, expressing with passion that unseen enemies wish him harm. It is up to me and the team to decide what to do next.
So, after hours of research on his past, talking to him and discussing his case with others, we eventually decide to detain him under the Mental Health Act. Understandably, he is furious and we quickly become the enemy, too.
This is what psychiatry can be, but not what most people understand.
Sometimes we need to detain those we perceive to be at risk and deprive liberty. Often the patient will understand months later – sometimes never. I will not pretend that this is easy and our decisions often replay in our minds in the early hours.
Do we make mistakes? Certainly. Do they haunt us? More than you know.
At a time when people speak frankly and openly online about their experiences of failed treatments, we psychiatrists are given the opportunity to consider where we are going wrong – which I consider a blessing.
The world of psychiatry is complicated and new research is often casting aspersions on conventional wisdom, meaning we have to be adaptable to changing our long held beliefs.
But the main challenge is how to eradicate the suffering of the one in four of us who do struggle with mental ill health each year.
My own entanglements with depression have made me more attuned to how others also facing this illness might be feeling – and I certainly feel it has made me more empathetic.
But I also understand that for some, this illness feels like something to be ashamed of and can be a barrier to seeking help.
This stigma can kill – plain and simple. I have met many men who deny illness to a level of feeling suicidal and the data shows that this is a real problem.
Right now rates of self-harm in the UK are the highest in Europe at 400 per 100,000 and suicide is the biggest killer of men under 45.
I want these people scared of receiving help to know that psychiatrists like me aren’t going to judge them. We’re not here to pathologise who you are as people; we are here to help you when you are feeling unwell.
When I first meet a patient I have usually read as much about them and their story as possible; their psychiatry history, reviews, comments and plans, diagnoses, medical problems and everything else.
My first step – and this can be the hardest part – is to help them feel at ease. Coming into hospital can be unpleasant, and if you are under a mental health section, usually confusing of even oppressing.
Next, we listen, gathering information to help put a plan together. Psychiatry is a complicated field and a diagnosis may take time to find, but we always have your best interests at heart.
Treatment depends on the condition, social factors, severity of illness and much more. Sometimes it can be as simple as prescribing a medication. It can be as complex as requesting imaging of someone’s brain, or as series as requiring electroconvulsive therapy (which can be life saving).
The crucial combination is to treat people as we approach illness, by looking at the biological, social and psychological factors. Illness affects all three of these domains, so to help someone, we must address them.
This could mean signposting therapy, assessing for suitable housing and support, and beginning a medication. Patients lives are not as straight forward as ticking boxes.
It can be hard today when the conversation around mental health – although much improved – is still not helpful to people in the midst of a personal crisis.
We still treat the concept of mental health problems as synonymous with moral depravity – with politicians like Donald Trump blaming mental health issues for crimes like mass shootings.
If we are to ever counter this damaging narrative, it has to start from the top down and everyone must get on board with using language more responsibly.
So on World Mental Health Day and beyond, I implore you to learn more. To listen, and reconsider what mental health means to you.
The man we saw on that early morning is still undergoing treatment. It will not be an easy journey for him, but we will help him as best we can.
In the end, we are all susceptible. However, through understanding, compassion and empathy we can make the world more mental health friendly.
There needs to be a realisation that all of us can indeed suffer – and we need not do so alone.
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