Sophie had experienced depression before, but last year it got really, really bad.
“[It was] hard to get out of bed,” she told Hack.
Warning: this story discusses suicide. If you or someone you know is struggling, please seek help. Call Lifeline on 13 11 14 or chat online here between 7pm and 4am.
“I couldn’t see the happiness in anything – any daily part of my life – and I just kept thinking about death and suicide.”
She describes the situation as “really scary”.
“I felt out of control of my feelings. It’s mainly repetitive thoughts about death. It’s a dark place.”
The feelings lasted for about two months, before Sophie decided she had to do something about it.
“I realised I couldn’t get out of this hole by myself, so I decided to go and see a GP and let her know how I was feeling,” she said.
If you or anyone you know needs help:
- Lifeline on 13 11 14
- Kids Helpline on 1800 551 800
- MensLine Australia on 1300 789 978
- Suicide Call Back Service on 1300 659 467
- Beyond Blue on 1300 224 636
- Headspace on 1800 650 890
- ReachOut at au.reachout.com
- Care Leavers Australasia Network (CLAN) on 1800 008 774
She went to a GP she’s seen once before, and was clear about what was going on in her head.
“I knew – and I told her – that I wasn’t going to kill myself. I just can’t escape these thoughts.”
Sophie’s doctor freaked out.
“As soon as I said I was thinking about death and suicide, her whole body language and facial expressions changed and she became instantly worried,” she said.
“She didn’t want me to leave her room that minute. She wanted to call the acute ward of the local hospital to come and pick me up and take me into an involuntary state there.”
Sophie said her doctor’s actions were counterproductive, because they made her lie about her illness.
“I started lying to her about things I was doing that day, and where my head was really at. Pretty much I said anything I could to escape that room. I felt she was going to lock me up,” she said.
“I had to explain myself for 20 minutes and pretty much beg her not to take me away on a stretcher to an acute ward and it was one of the scariest moments of my life,” she said.link
Involuntary admission “very, very rare”
Under different state and territory Mental Health Acts, doctors can refer patients for involuntarily admission to hospital if they are a risk to themselves or others. Once the patient arrives at hospital, they have to be assessed again by at least one doctor before being admitted. It’s called being scheduled or sectioned.
But as President of the Royal Australian College of GPs, Dr Bastian Seidel, told Hack, it’s not a decision doctors take lightly.
“Sometimes it happens when patients are under the influence of medication or certain drugs for example, and certainly are not capable of making a decision and then it would require an involuntary admission,” he said.
“But that happens very, very rarely.”
Bastian thinks Sophie’s doctor’s reaction was “over the top”.
“It’s certainly the last thing you want and need, and I don’t think it’s appropriate in the 21st Century,” he said.
There’s no set checklist that doctors have to follow in these circumstances, and Bastian reckons that’s a good thing.
“A one-size-fits all approach is never appropriate. It wouldn’t do the issue justice and it wouldn’t do the complex lives our patients live justice either,” he said.
If we’re relying on a one-size- fits all approach, then we would be failing.”
In order to be involuntarily admitted to hospital, you have to be a danger to yourself and others, and once you get there, at least one doctor has to agree that you need to be hospitalised without consent.
Sane Australia estimates that about one-third of hospital stays are involuntary – but don’t stress, because only a small proportion of illnesses require hospitalisation.
You can find out more about involuntary admissions through Sane Australia’s website.
Finding the care that works for you
The Royal Australian College of GPs recently completed a massive report on general practice.
It found that the number one reason people visit a GP is for psychological illness. In fact, three out of five doctors’ visits are made by patients who have concerns about their mental health.
Because of that, GPs are encouraged to up their skills when it comes to treating patients who present with mental health concerns.
“So there’s a very strong emphasis in the training program for GPs on mental health conditions,” he said.
Bastian thinks it’s important that patients talk to their regular GP if they’ve got mental health concerns – someone who they trust who knows their history and circumstances.
“It’s always difficult when you are speaking to a medical practitioner or a GP who doesn’t know you,” he said.
“To see someone who is referring you straight into a mental health unit is certainly the last thing you want and need.”
Bastian said there are questionnaires and other tools to help doctors navigate when a patient is suicidal, but it doesn’t compare to having a doctor who knows the danger signs because they know you well.
Room for improvement in health system
By and large, doctors do that really well. But Bianca Brijnath from the National Ageing Research Institute said there’s space to improve.
The challenge for GPs is yes, they may know how to manage it clinically very well, but the social side of it is where they face many challenges.”
What she means by that, is that doctors don’t necessarily have the skills to treat the root causes of some mental illnesses.
“It will be things around a relationship breakdown, maybe job loss, maybe some substance abuse involved, post-natal depression, there’s a whole range of issues and GPs aren’t really trained to deal with that,” Bianca said.
She reckons the health system could benefit from taking a more holistic approach to wellbeing, by linking GPs with other government services.
“It may include employment finding programs, it may include befriending initiatives, volunteering, friendship, peer support – a whole range of issues that go much much more than the clinical,” Bianca said.