Long Version

One of my younger patients progressively developed a mental health disorder with progressively worsening symptoms over time. I tried hard to have the patient’s see a psychologist and a private psychiatrist. They did not feel that Public Hospital Psychiatry was a realistic option.

While waiting for an appointment with a specialist psychiatrist, the patient developed more and more symptoms, bit by bit.

I added treatment, based on the symptoms developing. This was very effective and very much improved symptoms while waiting to see the specialist. The specialist unfortunately became sick and cancelled an appointment, further increasing waiting time , a lot.

The patient did eventually manage to see the specialist. His assessment was that he needed to build up a relationship with the patient before he could treat her. He left my medications as they were. This unfortunately meant that the only person willing and able to treat this patient was myself. The patients and their carer had a good relationship with me. The patients and their carer trusted me. The patients and their carer found that all the treatment I had started, worked to a good extent and made a real difference to the young patient’s life.

The patient according to all this was getting their life back and starting to do normal things _ getting out and about in the world and relating normally to friends, even considering returning back to the school system.

One day, after a shopping trip out, the patient and her carer returned home. The carer was unfortunately a bit slow securing the medications. (Locking them up). These were procedures put in place by myself and the carer to ensure the patient did not have a medication mishap.

The young patient impulsively swallowed a lot of one medication. (An overdose) Realising what they had done, the patient then rang the ambulance and went to hospital.

The overdose was fixed up in hospital but then “all” the medication was stopped by the hospital doctor involved, with a severe flare of psychiatric symptoms occurring over the next few weeks.

Patient and a carer again returned to me. It eventuated that the only person willing and able to treat this patient was myself. They were still stuck waiting for another psychiatrist appointment. The hospital appointments did not eventuate. The patient and their carer trusted me to get their psychiatric condition back on track to get rid of all the severe symptoms they had developed after having been discharged from hospital off their medication.

Again, I believed that it was Unethical , Dangerous and Immoral not to do as much as possible, to help this person by providing psychiatric care and support in the time waiting to see the specialist. It is not safe to leave her unattended and untreated. The situation was serious and there was potentially a life at stake.

The next specialist appointment was some time away. All three of us involved: myself, the patient and their carer all believed that something urgently needed to be done , and that I was to be trusted to do this.

I medicated the patient again successfully. All three of us involved , myself, the patient and their carer all believed that we had achieved a good outcome, improvement in psychiatric symptoms and a return to substantially enhanced safety for the patient.

In short, I was happy the situation was much improved and the patient and their carer were happy with the situation as well at times both before and after the overdose event.

The Medical Board (AHPRA) has taken the stance that my actions are dangerous and has restricted me from practising and from treating mental health disorders.

GPs should not be medicating patients for mental health conditions.

This is in spite of the fact that the patient got better from my care on two occasions. This in spite of the fact that the patient and their carer were happy with my care. This is in spite of the fact that the psychiatrist had not changed any of my medications when reviewing the patient.

The Medical Board’s (AHPRA's) actions in stopping me from treating this patient have not assisted the patient at all, according to the carer and the patient.

The dangerous events in this entire situation to me were:
The hospital doctor stopping all medications and failing to stabilise the patient’s psychiatric condition, and the hospital failing to provide long-term follow up of an at risk patient.
The Medical Board stopping my treatment of all mental health and drug patients in spite of my success in treating and caring for these patients. In my opinion they have given no consideration for the safety of ORT patients and mental health patents in my care.

(No other doctor in my practice and perhaps other practices would dare prescribe any medication for this patient and now for any other patient with a mental health condition in my care, seeing what had happened to me and fearing that this may indeed happen to them as well).

AHPRA has taken the stance that I am to be blamed for events. AHPRA, in my opinion, has also taken the stance that the care of several hundred ORT (Methadone and Buprenorphine) patients is not of worthy of any consideration of their safety and their medical care. To my opinion , the outcome of events looks like a Kangaroo court with a predetermined judgement of myself, with outcomes adverse to substance and mental health patients.

"No one" has been hurt or injured to trigger this event. In fact the patient at the base of this event has done very well and is happy with Dr P's treatment. In my opinion, the restrictions appear largely based on a dislike of ORT/mental health doctors in general. Many doctors also feel GPs should not be involved in treating mental health issues, shortage of these qualified doctors notwithstanding.

In my opinion the system is not very concerned about welfare of ORT patients and mental health patients if the system does not care about outcomes. To get in trouble for making people "well", is something life experiences would not prepare you for.

If you are interested read the Sunday Mail article at end of this page). Dr Pxxxx's patient did much much better than this.

The Medical Board’s brief is to protect the public. However I’m sure the patient involved in this mess does not feel very protected.

As a result of the restrictions imposed on me , the next serious consequence is that I now cannot continue prescribing or looking after several hundred of you , my ORT patients. The difficulties I understand you will face in finding a new prescriber for ORT are likely to be impossible. I also realise that in the context of my problems, any new prescriber will be very fearful prescribing you any mental health medications in association with your ORT.

The staff at Toombul have done as much as humanly possible to make the transition easy anhd as safe as possible. Dr P is not able to act in this regard in any capacity due to retrictions. Two working days warning were given by AHPRA to Dr P and the medical centre to make arrangements.

In my opinion, it looks like the system has no regard for the patients for whom I routinely look after and disregards their welfare.

In short, the Medical Board by its actions is significantly endangering your lives as well. They deserve your anger. But there is nothing I can do about the circumstances that have arisen. I have been told what I must do. I must comply with these instructions.

You are entitled to feel very unhappy about these circumstances. You have been put in a dangerous situation by an organisation (the medical board = AHPRA) which believes it is acting in the public interest but which in the current situation can be seen to be endangering the lives of the original patient and all of you.

The staff from the medical centre will provide you with a list of people to contact to get on the ORT program. Our medical Centre has made a special effort to make sure that everyone has a script at least to the end of February, perhaps a bit longer in some special circumstances.

Further Information About Care of Mental Health Patients.

Drug Addiction or substance use disorder is a mental health condition. There are difficulties getting on a program in Brisbane and there are difficulties getting treatment for other mental health conditions as well.

This article was in the Sunday Mail, a few days after my circumstances hit critical.This is not my patient, though the circumstances are very similar. My patient "got better" under my treatment, whereas the patient in the article had no one willing to treat her at all, it would seem in my opinion.

Sunday Mail Feb 6 2022

Bella, 15, has tried to take her life more than 20 times. Her parents are forced to watch her around the clock because the state's broken mental
Health system can't give her the treatment experts say she needs'. Today the family makes a powerful plea,

Bella 15 HAS TRIED TO TAKE HER OWN LIFE MORE THAN 20 TIMES. HER
WATCHFUL PARENTS FEAR TO LEAVE HER SIDE AMID TNIS HARROWING ORDEAL
BUT HOSPITALS SIMPLY SEND HER HOME WITHOUT THE CARE SHE NEEDS
Jackie SINNERTON
SPECIAL REPORT

A QUEENSLAND teenager who has tried to take her life more than 20 times is unable to get proper mental health treatment in the state's public hospitals, leaving her terrified.
Her parents need to watch her around the clock to keep her alive.

Bella has emerged as the face of Queensland's mental health crisis, and is being handballed between services in an underfunded and overwhelmed sector that experts say is failing to provide the intensive long-term psychological treatment she needs.

Dad Ty Irvine takes time off work to drive his daughter hundreds of kilometres each fortnight from their home in Kingaroy to Ipswich to see a private psychologist that costs the battler family an unsustainable hundreds of dollars per session.

Her parents lock up knives and medications at their home and sleep next to her.

In a desperate bid to finally get proper long-term treatment, the teen and her fearful and exhausted parents have decided to go public, with the backing of Bella's psychologist.
"I just want to get better and am happy to leave my mum and dad to get treated in a mental health ward. I need help," the brave teenager told The Sunday Mail.

Bella's psychologist said the girl was being let down badly by a health system that had no real understanding of mental health.
"Bella looks broken from the outside but has a level of authenticity that is strong. Long-term support and counselling would make such a difference to her," the psychologist said.
"She is an amazing girl who adores her family and genuinely wants help for herself for a better chance at life".

Mum Kel Irvine, who has cerebral palsy and is in a wheelchair, is a lioness when it comes to Bella. "She sleeps in our bedroom and we can't take our eyes off her," she said.
"Her poor little body is cut up so badly as she self-harms a couple of times a week. She often needs stitches. I will never give up on Bella.
"Every time she is taken into a hospital she is almost immediately sent home. She deserves so much more."

Bella ended up in Toowoomba Hospital last week after another serious episode of self-harm but again was released in a couple of days.
"It's just the same old story. Bella is sent home as quickly as possible with no solution. We are at our wits end," Ms Irvine said.
"She's got an appointment with her psych next week but we might have to cancel because we really can't afford it.
"I just feel like screaming, all stressed out."

Bella was a lively, active little girl up to the age of 13 when her mother says she was targeted online in a blackmail attempt by a predator.
"Bella has been in and out of hospital for almost two years now" Ms Irvine said.
The first time she was admitted to Toowoomba Hospital mental health ward in April 2020. She was treated for anorexia and was down to a weight 38kg.
Bella went back there a couple of more times.
She has been to Hospital more times that I can remember, sometimes every week but is always sent home."

Bella has been diagnosed with anorexia, borderline personality disorder, depression, anxiety and PTSD, but her psychologist believes she has been misdiagnosed.
"She hasn't been with the same practitioner long enough to get a proper diagnosis.
I am still investigating but I think Bella may have ADHD and autism, these are things that would make her more vulnerable to being groomed online," her psychologist said.
Professor Brett Emmerson, chair of the Queensland Branch of the Royal Australian and New Zealand College of Psychiatrists said a case of such severity should receive attention as soon as possible even in the overwhelmed mental health sector.
"If it is a borderline personality case, they can be a challenge as they usually do not do well in inpatient units. But reassessment of this case sounds like it is needed," Professor Ryerson said.

RANZCP has put in a submission to the ongoing parliamentary inquiry into ways to improve mental health outcomes for Queenslanders.
"We desperately need more funding. The state has the lowest investment per capita in this area than any other state.
A severe shortage of mental health professionals is crippling the mental health system," Professor Emmerson said.
The Queensland Family and Child Commission's 2019 to 2020 data shows suicide is the leading cause of death for 15 to 17year olds.

Bella's dad Ty is disappointed that the new $92m Kingaroy Hospital is unable to give Bella the treatment that she needs.

I can't' understand why the facilities weren't better in a brand new hospital," he said.
Health Minister Yvette D'Ath's office said that for patients with acute mental health illnesses, longer-term specialist inpatient care may be needed.

These patients are assessed clinically by the Kingaroy mental health team and, if required, are referred to the Acute Mental Health Unit at the Toowoomba Hospital.

It's always very saddening to hear of our young people struggling," Ms D'Ath said.

"The Palaszczuk government is deeply committed to improving mental health services for all Queenslanders.
"We have demonstrated our commitment by delivering enhanced mental health services for young Queenslanders, including the $27m Jacaranda Place, a 12 bed adolescent mental health treatment centre.

"Importantly, we are holding a parliamentary inquiry into mental health services in Queensland because we know that we need to shine a light on mental health and better understand the needs and demand pressures."

But Nanango MP Deb Frecklington said she was outraged by the lack of mental health services at the Kingaroy Hospital.
"There are no reported upgrades to mental health services in the new Kingaroy Hospital," Ms Frecklington said.

"Will there be a safe room (as we have needed for so long), or any inpatient mental health beds? The answer to this is no."
TO HELP: search for our site

Every day counts in urgent race to fix failing mental health system
Jackie Sinnerton

OPINION
"SERVICES are on the brink; people are not getting the treatment they need and the longer it goes on the more chronic people become"
These are the stark words of Professor Brett Emmerson, one of the state's most experienced .psychiatrists, and they ring too true for 15 year old Bella, who has been in desperate need of long-term mental health treatment for two years.

She is a teenager in crisis who is crying out for help , and sadly she is not the only one.

Vulnerable children are falling through the ever deepening cracks in the state's overwhelmed mental health system a system that is flailing due town appalling lack of funding and a shortage of trained staff.
Helplines are drowning in calls from kids who can't cope with life, it can take 18 months to get an appointment with a clinician and emergency departments are clogged with Queenslanders with urgent mental health needs.

We need services that offer the right help for Queenslanders such as Be11a.
Every day counts.

It's time that the state took the load off the shoulders of loving parents like the Irvines, who can barely allow themselves to breathe as they keep watch on a beautiful young girl who should be living the best years of her life.

The government's Mental Health Inquiry, which was launched in December, is very welcome.

Submissions on how to improve the system are open until February and the Mental Health Select Committee will deliver its report in May.
But there is no guarantee to act on it and the government is likely to drag its feet in implementing strategies to improve mental health care.

Sunday Mail Feb 6 2022 B

Long Version

Further Information About Care of Mental Health Patients.

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