Having just completed the first week of my psychiatry block, I thought I ought to take a minute or two to reflect on the week's past events and experiences. On the first day of my rotation, I was assigned to work in the ED and PECC Unit (Psychiatric Emergency Care Centre) with the psych team at a big tertiary hospital (BTH) in a somewhat notorious area of Sydney. The other members of my group were allocated mentors in the actual psych ward to follow around/work with - I assume there will be a swap-over at the half-way mark so that we may experience both settings. In brief, the experience has been more exciting and yet more exhausting than I could have ever imagined.
My shift is from 2pm-9pm everyday - partly so my time wouldn't coincide with other students' from other years/med schools, and partly because that was the busiest period in the day for the ED psych team. My team look after people who present to psych voluntarily or are brought in involuntarily.
The voluntary patients form the minority of presentations. These are generally cooperative patients - mainly middle-aged business men and women, or young overseas travellers - who are facing acute psychiatric crises (anxiety, panic attacks, adjustment disorders, suicidal ideations) that they want immediate help with then and there. Once they're cleared medically by the ED doctors (all patients have to be cleared medically before being been by psych) the psych team has a chat to them (read: talk for over an hour sometimes) about what's been happening now and in the past; determine their level of "risk"; before deciding whether to keep them in for observation in the PECC Unit overnight or referring them to the hospital psych outpatient service.
Now, in mentioning that the BTH that I'm working in was in a notorious part of Sydney, I really meant notorious for the involuntary pscyh patient presentations. In NSW (and possibly Australia-wide), a person can be scheduled for involuntary detainment/assessment/treatment by a mental health team under different sections of the law. What that basically means is that if a person is deemed to be (acutely) "Mentally Disordered" or "Mentally Ill" and are at imminent risk of harm (to themselves, their reputation, others, or by others) - the police, ambulance, community, or medical practitioner can bring them into/make them stay in hospital for a period of time until further action for their management is decided, against their will (of course the finer points of this are many, I'm just trying to be brief). This is actually a big deal, because there aren't many areas of the law here that restrict a person's freedom in this way and I guess if you haven't really thought about it in much detail, it's quite confronting to see how this arrangement takes place with some of the less-cooperative patients. Mind you, most of these patients are floridly psychotic and have very little insight about what's going on. But a couple of the patients we saw were presenting with first episodes of pscyhosis so the signs were very subtle, and would probably not be given any consideration in a different setting, e.g. laughing or smiling inappropriately during the interview. It's hard to put these signs forward to a patient that there might be something not quite right going on. Understandably, these patients denied having any abnormality, but were lucid and somewhat insightful enough to be upset by an involuntary schedule.
Despite all the prep-talks we were given about not getting emotionally-involved or upset by the stories around us, it's really hard not to feel anything, especially with the younger patients who are brought in with first episode psychoses. As my supervisor said, "the worst part is the process of going crazy.. once you're there, you don't have enough insight to realise what's going on". It's quite sad, I think.
Everything aside, the experience has been very eye-opening and fulfilling. Hoping to share more thoughts with you later..
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