An open-letter to psychiatrists

Ladies and Gentlemen, psychiatrists, I’m talking to you. There are a few simple precautions and measures to be taken to make your patients’ lives and recovery processes easier. Most of them should go without saying, but seeing as that's not always the case, I have decided to make a little list.

When you receive an initial call from a potential patient, don’t reject their ask for help just because they are contacting you from their own initiative without the recommendation of their doctor. If you are taking on new patients, you are taking on new patients, end of.

So okay, in France people who are over 25 are supposed to go through their GP to get to you (if they want to be reimbursed by social security at the usual rate), it’s what we call the treatment access protocol. But why not accept an initial appointment and ask them to get a referral letter in the meantime!

GPs tend to know one or two psychiatrists at the most -- if these are both in sector 2 [French system], not accepting new patients or unavailable for some reason, your patient is left to their own devices: not easy!

Even if there is an Insane article dedicated to helping you find a psychiatrist...

If you know that you’re soon to retire or move (the year or month will suffice, we’re not asking for your personal diary) when you take on a new patient: for goodness' sake, tell them! It will save them from starting treatment with a new doctor, going through their story potentially for the thousandth time, only to have to do it all again six months later.

That also goes for patients you are already following: as soon as you know of your departure, tell them. It will give them time to prepare themselves psychologically and, namely, to get organised and find a new psychiatrist! Waiting lists can sometimes last several months, so this really is an important point to stick by.

If you are retiring, moving, if it isn’t working out with one of your patients -- basically, if your patients have to find a new psychiatrist, where can they go? Have a list of colleagues at hand. And fyi, 2 isn’t enough, especially if they are in sector 2 or not subsidised by social security [French system]!

Psychologists, sophrologists and other psychotherapists are also mental health professionals. They too, play an important and perfectly compatible role to yours.

So:

• Be able to recommend a few to your patients

 

• Make sure you understand, from these professionals themselves, what their work consists of and what methods they use

• Ask your new patients if they are already consulting by such therapists, so that, if appropriate, you could be in contact (in the same way that you should be in contact with your patients’ GPs)

Medication is great, therapy is even better, given that, unlike pharmacological treatment, it has no side effects. So have a list of psychologists, psychotherapists handy, but also peer-support groups, organisations, books your patients might find helpful.

It will be less expensive for the social security and will avoid patients for whom medication is not the best or only option being treated for years on end to no avail. This will free up space for new patients, cf my first point.

• Keep your knowledge of medications up to date: check if there isn’t a new, more practical option (chopping a tablet in two makes its absorption more difficult if it isn’t designed for it, I’m not teaching you anything new!), if there is a way of avoiding disgusting tastes (by prescribing tablets rather than liquids for example), if a medication is easily available abroad (if your patient travels a lot)... This will help them respect their treatment (“better observance”, in your jargon).

• Asking about the family and professional situation of your patient also implies asking them how long it takes them to commute to your office, as well as the transport options and their childcare arrangements. This will mean you are able to not offer up impossible appointments every time, squeeze them in between others in case of an emergency if you know they live nearby and suggest a schedule that is adapted and realistic to maximise the chances of them sticking to the treatment plan...

• Make sure your office is accessible to people with a physical or mobility disability. Surely that’s a basic minimum, especially given that people with such handicaps are also more likely to have a psychological disability as well

• Be easily contactable. That doesn’t mean over longer time periods or giving your personal phone number.
• A professional email address can easily avoid you accidentally standing someone up because your secretary is shut after 5 pm or on the weekend.

 

• Offering Skype consultations, especially when you know you won’t have to give prescriptions during that appointment, could help your patient not waste time and money on the commute, whilst still preserving the precious face-to-face time. PS: you can also send a prescription via the post if needed... don’t hesitate if that can help maximise your Skype appointments !

 

• Informing your patients systematically of ressources they can contact when you are not available is an essential precaution to take. Psychiatric A&E departments, as well as suicide prevention helplines, text numbers or online chat services for young people, mental health organisation helplines... Some examples at the end of the article.

Even temporary, even with reservation, tell your patient what is wrong with them if you can identify it! Obviously, this is when you remind them that a diagnosis is not definite, nor a label for life, but that it’s important to be aware that it’s a first step towards recovery. Someone who isn’t well needs to know why, it’s understandable that it’s much harder to accept treatment or have hope when one doesn’t even know what’s wrong.

And it’s also your ethical obligation too: we know that treating the symptoms and not the root cause is insufficient, and frankly it’s not reassuring to think you’re just trying out a cocktail of medications randomly because you haven’t identified the problem. We’re not in Dr House! In real life, people need answers to start to (re)build themselves.

For those amongst your patients for whom you know the diagnosis but are worried about stigma (on a whim, let’s say schizophrenia for instance), tell them anyway, for goodness sake! If not, all you’re doing is adding to the taboo and preventing the individual from finding the help they need (peer support, organisations etc.).

Trust your patients and you’ll see that the therapeutic relationship will be far more effective.

Are you unable to take on new patients? Ensure that the person at the other end of the line:

• Has a GP they trust (if not, recommend one)

• Has one or several close friends or family members they can confide in

• Has the contact details of local psychiatric A&E services and knows they can go there as soon as they feel the need (and not just in case of detailed suicidal ideation)

 

• Point them systematically towards colleague psychiatrists or the local public psychiatric centre in their sector, and if they seem hesitant, reassure them regarding the treatment and insist they make contact

This is the basic minimum, because there is nothing worse, when one is unwell and reaches out for help than to be met with a “no sorry I’m not taking on anyone new, bye” or “no you are too young / poor / live too far away we can’t see each other, soz.” Especially if you’re shy. Especially if you don’t really trust doctors much. Especially if you're exhausted by depression. That’s how you land in A&E after a suicide attempt or in the news columns after the fact.

If you are in a position of responsibility, you have the possibility to help avoid such tragedies. Do your job.

• Reach out to the Crisis Text Line if you're in the US, Canda, UK or Ireland, by text or by Facebook message. They're available 24/7 to whomever feels the need to chat (you don't need to be on the verge of suicide to text them!)

• If you'd prefer to hear a human voice on the phone rather than text, you can call the Samaritans if you're in the UK. You can also chat with them online, write them an email or a letter, or use their self-help app to soothe yourself on your own

• If you'd rather talk to a human being face-to-face, please go to the nearest ER, psychiatric if possible (you can google that in your area)

•   Pro tip: pretty much wherever you are in the world, if you type "suicide" in the Google search bar, you'll be provided with local ressources to help you