Kathleen Lynch and psychiatric services as the stepchild of the health system

LookingFor

My brother was admitted to the psychiatric ward of a hospital about a month ago after months of inadequate 'care in the community' thanks to cutbacks in 1:1 therapy support in the mental health services.

The experience since has been an eye opening one regarding mental health services in this country. I could write at length, but let me highlight just one of the tragic-comic issues facing mental health services here today.

My brother's condition is complex, and part of his overall medical condition has been a dramatic drop in weight, and a difficulty in regaining weight. Despite the psychiatrist and psychiatric nurses best efforts he has not gained any weight in the month since being admitted.

You'd think - and of course, you'd be right - that the psychiatric staff would call in doctors and specialists from other areas to help with these aspects of a patient's condition. And they did. But guess what? Some medical professionals - specifically in this case, dieticians - simply refuse to work with psychiatric departments at all. There apparently is a snobbery between different departments within hospitals and psychiatric nursing is, for example, not considered to be on the same 'level' as other nursing.

And so, my brother remains without the help of a dietician for weeks now. A letter was sent to both the HSE and the hospital administration. In fairness, the HSE completely agrees with us and my brothers psychiatrist, that this is a unacceptable situation, and they've offered to provide funding to engage a dietician privately if the hospital staff continue to refuse. However still two weeks later there has been no movement because the hospital's dieticians are steadfast about not working with psychiatric staff, and my brother's psychiatrist will probably have to reach out externally to bring someone in. All wasted time, needless delays.

Now obviously not every other department is like this. Gastroenterology saw my brother with no issue. But it is shocking that this kind of system is in place where some supposed professionals can unilaterally withhold care from certain patients, and it seems nobody can direct them differently. Politicians talk about removing the stigma around mental health, but they're presiding over a system that itself discriminates. The stigma isn't just out there amongst the public, its present within and between hospital departments.

I am not sure how Kathleen Lynch can say that she 'could not accept the suggestion that patients were not being properly treated' in response to comments from the Psychiatric Nurses Association (see: http://www.rte.ie/news/2014/0420/609970-psychiatric-nurses-call-for-more-efficient-system/). My experience is mild compared to some others but I feel like people need to know this, and that all of this needs to be a much bigger scandal than it is. Some people aren't even getting help and those that are, it can be limited - not by resource shortage - but by petty fiefdom type mentally within the health system. It's a mess.

Dingle_berry

Is there a professional body for dieticians that you could make a complaint to?
Would it help if someone from your brothers primary care team either met with or wrote to the dietetics department to resolve whatever concerns or issues they have?

With reference to your comment about psyc v general nursing, It's very common for each group (and sub group) of health care workers to think of themselves as the martyrs and un-sung heroes of medicine. I'm not sure where it comes from, most likely from lack of knowledge of others roles and responsibilities. Unfortunately it prevents good teamwork and communication.

LookingFor

Dingle_berry wrote: »

Is there a professional body for dieticians that you could make a complaint to?
Would it help if someone from your brothers primary care team either met with or wrote to the dietetics department to resolve whatever concerns or issues they have?

With reference to your comment about psyc v general nursing, It's very common for each group (and sub group) of health care workers to think of themselves as the martyrs and un-sung heroes of medicine. I'm not sure where it comes from, most likely from lack of knowledge of others roles and responsibilities. Unfortunately it prevents good teamwork and communication.

Thanks for reading and replying

Will definitely look into whether there's a professional body we should complain to, although that will probably come down the line a little bit. His doctor has been in contact multiple times with dietetics - they just refuse to deal with psychiatry.

For sure, we're getting one side of the story here, but that we're dealing with 'sides' at all seems appalling to me as a lay person. Medical professionals should care for patients whether they're under their own 'home' department or not. Patients shouldn't be suffering because of the hospital equivalent of office politics or whatever, but they are.

Dingle_berry

LookingFor wrote: »

Thanks for reading and replying

Will definitely look into whether there's a professional body we should complain to, although that will probably come down the line a little bit. His doctor has been in contact multiple times with dietetics - they just refuse to deal with psychiatry.

For sure, we're getting one side of the story here, but that we're dealing with 'sides' at all seems appalling to me as a lay person. Medical professionals should care for patients whether they're under their own 'home' department or not. Patients shouldn't be suffering because of the hospital equivalent of office politics or whatever, but they are.

I would imagine that a health care professional would have to have very strong reasons to deny a patient their attention. Have you written to the department yourself to ask for their reason? Getting in in writing will facilitate any complaint.

From my experience all healthcare professionals do provide the best care they individually can to patients. My comments about the office politics were in reference to the attitudes you observed between nurses. I'm as surprised as you are at your brothers situation and if I were in that situation I would make a documented complaint.

sam34

I'd imagine that the issue is that in terms of funding and governance the psych unit is separate from the acute (general) hospital system and thus employees of the acute hospital don't technically have to provide a service to the psych unit, even though it may be located in the general hospital.

It's happened in most if not all psych units I've worked in. It's not just dieticians either, it can be phlebotomy, ECG technicians, even porters.

It's infuriating, frustrating and difficult to navigate. As a psychiatrist you often end up fighting for resources like this for your patients - It's yet another way in which they are insidiously discriminated against.

Dingle_berry

sam34 wrote: »

I'd imagine that the issue is that in terms of funding and governance the psych unit is separate from the acute (general) hospital system and thus employees of the acute hospital don't technically have to provide a service to the psych unit, even though it may be located in the general hospital.

It's happened in most if not all psych units I've worked in. It's not just dieticians either, it can be phlebotomy, ECG technicians, even porters.

I'm surprised and for some reason shocked at that. It seems almost too ridiculous to be true!

sam34 wrote: »

It's infuriating, frustrating and difficult to navigate. As a psychiatrist you often end up fighting for resources like this for your patients - It's yet another way in which they are insidiously discriminated against.

It would make me furious as well. It's a poor use of your time and professional expertise too. I've heard oncologists and immunologists giving out about having to justify therapies to financial departments but imagine if they had to fight to get phlebotomy, radiology, etc done!
I've worked in general hospitals, at least one had a psychiatric department. We would get samples from the psyc dept but always assume that it's just like getting a sample from any other ward.

sam34

Dingle_berry wrote: »

I'm surprised and for some reason shocked at that. It seems almost too ridiculous to be true!


It would make me furious as well. It's a poor use of your time and professional expertise too. I've heard oncologists and immunologists giving out about having to justify therapies to financial departments but imagine if they had to fight to get phlebotomy, radiology, etc done!
I've worked in general hospitals, at least one had a psychiatric department. We would get samples from the psyc dept but always assume that it's just like getting a sample from any other ward.

If I sound jaded and cynical about it, it's because I am. It really beggars belief.

I'll give you another example... One hospital would not provide phlebotomy cover to the psych ward. The psych in-patients were 'allowed' go to the blood room the same as out-patients, except they could only go during a specific one hour period daily and only if accompanied by a nurse. No consideration was given to the fact that it could have been a little old lady who was in for depression, they were "psych patients" so were deemed to need a nurse escort and restricted access to the blood room.

gussieg

As a long time client of psychiatric/social services in this country, i can recall fondly those individuals who genuinely cared about me and the distress i found myself in, due to life experiences, and my solutions to same.
As to those who would not or could not care because of their own personal shortcomings or situations, i dont know why i still continue to be so shocked dismayed and surprised that this is the case.
Even family members who have been subject to similar attitudes and worse treatment , have sadly been brainwashed into learning these reactions when in a position to decide whether to help someone , or not help them.
Anyway. As a result of better to good care i received elsewhere, i made a promise to myself that i would like to be in a position to 'give something back' to thank those who had helped me, often with no visible reward.
So i got admitted to college over 10 years ago, and despite my social inadequacies, and thanks to the kindness and patience of the college, i managed to pass the first year of my course, gaining the ITEC diploma in Holistic Massage and would you believe, professionalism. The other sections, which included Diet & Nutrition, Stress Management treatment, Reflexology i failed to obtain these diplomas, mainly due to getting into needless conflicts with some staff who were dealing with their own stuff at the same time.
I was not well regarded or liked by those i studied or taught under, but i am still alive and so very glad i did try to do this course.
My biggest fault? Not keeping my mouth shut.
And then one of the greatest defects of any working professional in any career, keeping time.

gussieg

Its never too late to finish though, diet and nutrition was really the most important part of the course as its the one part that i have found has the most potential for lifechanging healing and miraculous recoveries along with the other treatments, such as reiki, massage, tai chi and meditation.