For the last 9 weeks, I have had the pleasure of doing my psychiatry rotation at Eastern Health, which I found to be an amazing experience. Within the commmunity, the mere mention of the term ‘psychiatry’ often brings a sense of bewilderment or disdain. The stigma surrounding psychiatry is real - we had to do an assignment around it, and at first, I was surprised at the idea that we had to write 1000 words about the very concept of how a field of medicine is perceived socially. However, I realise it to be true - upon revealing to my friends and peers that I am doing psychiatry, I have received more often than not funny looks and condescending comments.

Psychiatry has been so eye opening because it has given me a perspective into a world that is so different to much of medicine - that is, many of the patients in psychiatry do not want to be treated in their health service. Unlike patients with physical health problems, the very nature of the conditions that patients with mental health problems experience mean that they are less likely to engage with doctors, to want to be treated - they potentially think that they are not experiencing symptoms because of their condition - lacking capacity to understand their condition.

Furthermore, those physically ill don’t always have a childhood component that makes change difficult - which is one very sad thing about psychiatry - that is, personality disorders and other disorders like borderline personality disorder often have a childhood component - such as childhood trauma, child sexual abuse, family violence, poor attachment to family or distant parenting styles - which leave a lifelong mark on these patients. The rate of relapse in mental health is also high due to the difficulty of things like staying clean drug-wise and adhering to pschiatric management plans and psychotherapy.

Treating patients who sometimes don’t want to be treated means that the law must come into play here - and this is where the Mental Health Act comes into play. The MHA goes against patient autonomy for the purpose of reducing risk and harm - and means that doctors and clinicians, who include mental health nurses, social workers - and who like the doctors conduct assessments with the patients - go against a principle which we were taught in the early years of medical school.

It can seem so demeaning to patients to basically lock them up - the psych ward feels like a jail - where you’re not allowed to leave. I sometimes think to myself - who in society are suffering the most - and having experienced this rotation, I think it must be mental health patients.

It must also be so tough on the clinicians - who treat patients against their will, who take the emotional load of the patients. It is often said that it is so important for the team to gel together well - and this is especially pertinent in psych - where the public mental health sectors is often already under-resourced and lacking in morale. There is so much redundancy - including overstaffing in some areas and understaffing in areas - as well as consultant jobs that no one wants to fill. The psych ward is always filled - and it doesn’t look like it’s slowing down.

The private psych world is also said to be very lucrative - but the greatest need is in the underfunded public system - from what I’ve been told by the doctors. The irony of the public system having fewer ECT resources, for example, but that it is where they are needed the most - while in privateland, patients who can afford to pay can have greater access to these resources.

Many of the patients on my psychiatry rotation are also people who would outwardly not normally be in my circles. Most of my friends have a university degree or are doing university, have stable income and accommodation, don’t use illicit drugs and have supportive families. However, I don’t wish to negate the lived experiences of my friends who do suffer from mental health problems or have the above risk factors. It therefore adds a layer of difficulty - to understand patients who often, but not always, have different experiences to us.

I had four different rotations during my rotation - which highlighted the breadth of workplaces that a psychiatrist could work in.

  • The CATT team was where we drove out to patients in the community who might be going through acute crises, or who might be recovering and need to be monitored in their management.
  • IPU is essentially a euphemism for the psych ward - where patients under the Mental Health Act are prohibited from leaving and treated, sometimes against their will, until they are deemed safe to others and themselves to leave.
  • The CL team is the consultation liasion where non-psychiatry departments like ICU (where there were many drug overdoses - intentional and non-intentional), dementias and deliriums, contact psychiatry to do a review on a patient. This is to ensure that if the patient has a psychiatric condition secondary to their primary concern, that they are treated and managed for this as well.
  • The PAPU team is the short stay unit of psychiatry, where patients of lower acuity are admitted for potentially a few days until their acute crisis is over. However, given the oversaturation of the psychiatry wards, some patients in this area were often quite sick.

Finally, I wish to talk about the euphemism treadmill and language used in psychiatry. Patients in psychiatry are called ‘consumers’ - controversially - according to some doctors I spoke with. Some think it connotes agency on the part of the patient - that they are choosing to be there and it is less paternalistic compared to them being ‘patients’ to the ‘doctors’. Others thought that it was colder and that patients are just there to be nothing more than ‘consumers’ in a big, hospital system.

The euphemisms used to describe patients often become dysphemisms in psychiatry due to the stigma associated with conditions. I think of terms like ‘r*tard’ - which initially originated from Latin (think ‘tardy’ being late). Patients sometimes are called ‘very sick’ or ‘ill’ when they are experiencing severe psychiatric symptoms as well - which I find interesting as well - because I normally associated these with physical symptoms. Anyway, some food for thought.