Death by hopelessness

Are we assessing and treating mental illness with the same urgency as we are physical complaints?  This becomes one of those columns with more questions than answers. It’s purpose is to highlight the plight of families in these situations.

I have become aware of several instances where patients suffering from mental illness and their families are left wandering in the dark. They are caught in a no-man’s land of conflict with patient confidentiality and privacy legislation, a need to access resources or information within that system and a system that doesn’t always recognize the toll that mental illness exacts on the loved ones of those who suffer, as well as the often terminal nature of these diseases. And by terminal, I mean death. By addiction, by suicide, by living on the street.  It is death by hopelessness.

There can be precious few supports or resources for the patient’s themselves or their suffering family members. On top of that, many people suffering from mental health issues have limited insight as to the severity of their illness or their need for treatment.  Where do families go then?  What do they do?  Especially where that family member is not a minor.  Information is rarely shared with family, even though and when they have become the caretakers.

When those families, desperate for help, present to an emergency room with a family member threatening suicide or self harm, what happens then? Often the patient is examined, and frequently discharged home if they promise to follow up with outpatient services.

There are long waits for psychiatric services and mental health services in every jurisdiction, and these resources are completely absent in others. Recently, I have heard of several families with adult children that have found themselves in desperate straits. A juxtaposition of their experiences follow, but you will see a common thread.

In each case the family presented to an ER or an outpatient clinic with their adult child.  In each case they were advised that their pleas for an urgent appointment could not be met. It was felt that their concerns were not that urgent, their insistence that their (adult) child was suicidal was overstated. That requests for information in the case of assessments could not be shared because of privacy legislation.

There was no recognition that family members tend to know their loved ones best. They are often the best observers of what is normal for their loved one, and what is downright alarming; and yet, how often are friends or family members interviewed as part of the mental health assessment in adult children, especially if permission is not granted by the adult child to discuss their condition. How can we best establish guidelines around these situations?  Protecting the privacy of the patient, yet obtaining a fully rounded picture of the patient and their situation by speaking with friends or family members? What about those patients suffering from co-morbidities of mental illness and addiction, a very common scenario?

Then what can be done, when desperate friends or family members meet nothing but closed doors? Their very real fears that “the experts” could be wrong? What about the fear of the families who have not been informed, but to whom the patient returns to for care? We in health care, know that we can never fully predict a crisis, mental or physical, in any one individual. Are we recognizing and treating a plunge downwards before it is too late?

We do not know what may precipitate a crisis in any one individual struggling with mental illness, and especially where you add on the “wild card” of addiction.

I can’t help but make the observation that we don’t have any expectation of predictability in emergencies involving our physical health; we have to adopt the same mind set for mental health and develop services accordingly. And once recognized, we need to treat mental health crises with the same urgency, the same rapid response, that we would accord a physical crisis; a stroke, a heart attack, a trauma call. We must treat a rapid and precipitate downward spiral into self abuse and mental illness, which has the exact same potential for a fatal outcome, with the same urgency and responsiveness. In society today and in health care generally, mental health crises are not treated with the same respect and care that a physical health crisis or trauma would be.

Are we equipped to manage the multiple faces of this issue?

The pain and anguish of mental illness is as gut wrenching as any physical illness and just as fatal. The collateral damage to families and finances is huge. Counseling and coaching by social workers and psychologists is not covered by most provincial health care programs, except in certain circumstances, and again, long waits are usually involved.  Time that many people do not have.

Please let’s not go back in time. Let’s not return to those days when those suffering from physical illness were treated with sympathy, support and the best that knowledge and technology had to offer and people with mental illness were treated with fear, contempt and indeed were outcasts of society and particularly those suffering from both illness and addiction.

Presently, death from mental illness are statistics captured under whatever physical cause led to their death, overdose, heart failure, asphyxiation.  Their true suffering does not even become a footnote in the sad chapter on the toll that mental illness can take.