“I was always aware, reading Chesterton, that there was someone writing this who rejoiced in words, who deployed them on the page as an artist deploys paint upon his palette. Behind every Chesterton sentence, there was someone painting with words, and it seemed to me that at the end of any particular good sentence or any perfectly-put paradox, you could hear the author, somewhere behind the scenes, giggling with delight. ”
- Neil Gaiman, “The View From The Cheap Seats”
The challenges of referring patients with mental health issues in primary care to the Psychiatry service (For tonight’s #Healthxph Tweetchat)
A few days ago, a respected individual learned announced on his Facebook wall that he was going to throw in the towel, and was going to say goodbye to the world. By virtue of his status update, he was able to call to attention his readers, students and friends, who became alarmed at implicit declaration that he was going to end his life. They all became extremely worried, and exhausted all means to reach him before he could do something to harm himself. One of his friends called a psychiatrist for an opinion, and they were advised certain steps to take, and eventually, after everything, the situation was deescalated.
After the incident, his posts took on a more positive note, which made people believe that the worst was over. In a series of “likes” and positive posts, it seemed all was well. Yet, that unfortunate crisis left his friends frantic at the time, not knowing what to do, and hanging their head at the burden of the possibility…”What if he had really done it? I wouldn’t have been able to do anything!”
Well, this is not something uncommon. With social media being ingrained in our lives, it is commonplace to see people dealing with mental health issues online. For the aforementioned individual, all was well and good, because someone reached out to him. But what of the distressed relative, or non-health care practitioner who does not know how or where to go for help? Or, in practice, what of the physician who has a patient who walks in his clinic “hearing voices” when there is no one there, or who wants to kill himself/herself? Or what of the in-patient attending who encounters a challenging patient who one day, suddenly refuses to eat, sleep, talk, or worse, refuses treatment outright?
All these are legitimate reasons for referring to mental health professionals, psychiatrists in particular, for further management. However, it is never as easy as ushering your patient on to the nearest psychiatrist’s door. Or telling the patient to see one outright, the way you would refer to the, say, ophthalmologist, or the otolaryngology specialist, among others. There is a certain ‘flavor” with referring to a psychiatrist that is met with some initial hesitation, or in extreme cases, vehement disagreement outright. The stigma of mental illness is particularly strong in our present society and time.
In a study by Ballester and group,(2015), it was agreed upong that general practitioners indicated that they perceived the mental health problems among their clientele, but the diagnosis and treatment of these problems are still seen as a task for specialists. This is not a surprise, because of in a study of 531 general practitioners (Phongsavan), Mental health problems recognised by general practitioners at least once per week were psychosomatic (93%), emotional (89%), addiction (79%), social/economic (71%) and family (69%), two-thirds recognised sexual problems, sexual abuse and major psychiatric problems less frequently than once per week. Sixty-four per cent of general practitioners reported that patients felt uncomfortable about being referred to psychiatrists; 53% complained that that referral service waiting lists were too long; 51% deemed that they were insufficient local mental health services; and 25% indicated that communication difficulties between referring general practitioners and mental health specialists obstructed optimal care.
These are things we have had experiences with, at one point or another in our careers. How do we do this? What do we say? Which brings us to our topic for tonight’s tweetchat:
T1 In your experience, what are the usual reasons/factors that would make you decide to refer to a psychiatrist?
T2. What factors particularly hinder your referral to a psychiatrist?
T3. What are your recommendations to facilitate ease of referral by practitioners to psychiatry service?
For everyone, this tweetchat is a weekly event (Saturdays, 9PM) on Twitter, hosted by members of #Healthxph, with different participants, discussing relevant medical topics using the social media platform Twitter. To join in the discussion, type #Healthxph on search and stay with the latest posts.
“The final twist of secrecy; lives hidden from themselves. Memories lost. “I just don’t remember anymore, ” they say blankly to their children or grandchildren. Lives leaving not a trace, just shadows…” – Alexandra Johnson ( From Leaving a trace: On keeping a journal, the art of transforming A Life into Stories.)
“Hey Matt, have you seen these babies?” I asked my 9 year-old nephew one time, while we were having lunch at their place.
“Sure, tita, they’ve been there for about 3 days already…” he said to me, referring to the new hamsters.
“For real?” I asked. He just smiled and shrugged his shoulders, and went ahead to join the others.
I stuck around for a little longer, staring at how amazing it was that they were so miniturized they were, and yet all their organs were working, all their paws were formed, right down to the littlest claws. Amazed at how such things could survive, I snapped away with my phone camera, wanting to capture the beauty of their movements. Everything was fascinating up close, and I was in awe at how I could see their organs beating through their nearly-transparent skin.
Despite the fact that these are tiny creatures were rodents, and could be considered vermin, they were in this primordial form, and it never failed to amaze me to see how surely they took their deep breaths of air into their little lungs, and how determined they were to seek out their mother’s teats to survive on the milk from them.
Although posting this photo may make it seem like it is in bad taste, I’ll do it anyway, as it is a good exercise in seeing how these tiny forms remind us of how great things are (however small they may be), when they happen. Viewing the world with a sense of wonder, always makes things worthwhile.
Lady in Green trying to squeeze through the throng of devotees of St. Anthony. Sibulan, June 2016.