Mopping Up Mental Health

I went to the clinic on Friday.  Quite cheerful I was when I arrived there and ready to get things DID. I shuffled past the HIV and AIDS Section.  The Reproductive Health Section with many blushing teenagers and finally turned the corner at the clinic to head to the mental health “corner”.  I paused briefly to think that the signage is intended to be functional, it screamingly communicates and impacts on the people waiting so much more.  What would you say if a friend passes you by in the HIV queue?  Hi, I’m here for a fun check? Blushes and shuffles feet? Anyways, almost fittingly,  the mental health section is in the most inconvenient area that is too small to seat the large number of people who require a service on mental health Friday’s. Yes.  On Fridays, when the psychiatrist graces the mentally ill with his or her presence and the nurse (no mental health specialisation) who are at their most tired, open the clinic to the mad, crazy and otherwise, on condition that you are prepared to queue from 4 in the morning outside.

As I lodged myself into the long queue, with an approximate waiting time of two hours for two people (not exaggerating), we all waited anxiously, knowing that although you were at a health centre, and could have braved massive odds to get there, there was no guarantee that you would actually receive the service you required regardless of  how serious your ailment is or what you’d come for.  In my hard-won um, experience, I have learnt that the South African Health System is more adept at turning people away than it is at servicing people who need it the most.  As an example, I had a close friend with mental illness tell me that when they were suicidal and reported to a hospital, they were told to come back when they had more serious symptoms.  I’m sorry did I miss something here?  A symptom of suicide?  Well.

I had come for a meds refill.  Not that hard.  I had a script, a detailed psychiatric history and referral letter from my resident psychiatrist.  So you could say I was capacitated to come and that the paper could speak for me because you know, someone with mental health anything is NOT able to do that.  Like we may have years of experience of living and coping with our disorders, but cannot describe our symptoms unless a psychiatrist decodes the language we apparently speak. center  Symptom of suicide indeed.

I no longer know what it will take to draw attention to the needs of the mentally ill in our families and communities in Africa because I have it unfortunately on great authority that we are fully and fundamentally being failed. We should not be turned away,  or have it suggested that we actively go home and allow our mental health to deteriorate. Because we matter.  Our families matter.  Our communities matter. And research/statistics in our country and the world says that mental health issues are undetected, and ravaging communities.  So perhaps, mental health services need to be primed to helping people not making them sicker?  In the meantime, whilst I mull this over, I am going to take that cleaner’s bucket which became so intimately acquainted with the tender flesh on my knees during the time I should not have waited, and I’m going to mop clean at the local clinic.  Be part of those who support us as opposed to those who don’t.  I am 4 M’s Bipolar Mom.

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Dear Patient

Dear patients,

Stigma is ever present when it comes to mental health, but I feel that it needs to be addressed. It needs to be addressed over and over and over. I have never been so proud to sound like a broken record. I got into health care to break stigmas. I didn’t want patients to feel like their needs and concerns weren’t heard. I didn’t want patients to feel like they were being judged. Honest to God, I don’t judge a single patient.

I don’t judge you for having multiple partners.

I don’t judge you for being on Medicaid.

I don’t judge you because you are gay.

I don’t judge you for your addictions.

I judge people based on their character and I won’t apologize. Don’t be a shitty human. The end.

I have to say something about my experiences because I hope that it breaks the stigma of health care and mental health. I do not get up before daylight and work a 12 hour shift for the money. I don’t sit and listen to other people’s issues at some of the most vulnerable time in their lives for money. 99% of people in health care are there because they truly want to make a positive impact. We ask the same question to every single patient over the age of 12. “In the past two weeks have you been feeling down, hopeless, or depressed?”

I get so many different answers but few anger me, disgust me, and make me forget why I am in the field I am in. I want to scream at you.

It isn’t funny, don’t laugh.

It isn’t something you can jokingly say, “yes, all the time” to.

There are so many people who burst into tears as they admit that yes, yes they do feel this way. It is okay to feel this way. “I’m glad you’re here today.” That is what I say. That is what someone told me, and that is what I will say to every single person who is strong enough to say what is most certainly a hard thing to say out loud. Today, I had to out myself. I am an open book and if you ask I will tell. I don’t walk around telling people I have bipolar. I pretend. I tell half truths.

“I couldn’t sleep.” And I stayed up until 4 AM compulsively making nonsensical lists that didn’t need to be made.

“I am just not feeling it today.” I barely got out of bed and forced myself to shower after three days of not doing so.

“I’m just not talkative.” I am afraid I am going to explode on you so I am choosing silence.

Today, I did none of that. Today, I told my coworkers that I have a mental illness, I struggle to function a lot of the time, I am just like that patient you called crazy, and I am sick of hearing them talk about people I relate to so much. Your doctor’s office is a safe space. An asylum where you can be open, honest, and seek help. Shame on them, not us. Today, I was someone I do not know. I hope you know that I am honored that you trust me. I am a safe haven. I will never downplay your concerns, symptoms, or feelings. You are someone’s parent, child, sibling, best friend, or coworker. I will treat you as I want myself and those I love to be treated. Without you, I would not have a purpose or a job.

Even the assholes who choose to believe that you are immune to depression.

Please don’t be ashamed. I am at times, but never too ashamed to ask for help.

Forever your biggest advocate,

Bailey

P.S. I have an appointment tomorrow with a new health care provider. Let’s hope she is one of the good ones.

Mental Health Matters

In my last post I talked about the importance of living in a way that promotes the positive, that celebrates the good, because frankly people / this person with mental illness NEEDS that.  That extra dose of sunshine that sometimes we just don’t get. Over the course of the last few weeks, for my sins, I have in South Africa been engaged about our National Health Insurance, about the provision of services, particularly mental health services.  Ok, I just read that back and laughed out loud.   Literally. No, we don’t have a great frame of reference.

In the one meeting a healthworker suggested that another strike be held to demonstrate what they thought.  What they believed.  Now as I’ve become increasingly Bipolar, my ability to have a poker face has become near to completely impossible, and I showed my disgust.  I mean, isn’t the basic premise of working in the health system that you’d rather not have people die?  That patients needed to stay alive to be treated, and when they did, you’d offer them the best possible service that you could manage within your constraints?   Wouldn’t that be what anyone wanted to do?  I’m not a healthworker, but I thought that was important.  That I wouldn’t want the healthworker I’d need when I was vulnerable to not be there, on strike, or otherwise predisposed.  And that’s pretty much what happens to people with mental illness whether the clinic / hospital is open or closed.  We don’t receive services because sometimes we don’t know we’re ill, sometimes we’re pushed to the back of the row, or triaged as “ok” unless you were slightly more important i.e. dying from a suicide attempt.  Awesome.

From everything I listened to – another person calling our health system – in a conference – Schizophrenic.  I stood up.  I said please don’t say that.  That’s racist to me and everyone who has a mental illness – who my good people – will exceed the number of people living with communicable diseases in the all to near future. Unfortunately.  So I have a better idea.  Let’s start a new conversation.  Let’s start a loud and proud new narrative that brings about fundamental changes to the mental health system the world over.  Let us find the money to provide the kind of mental health services that everyone needs at some point in their lives.  Because actually, people with mental illness in the world are no longer a minority.

Because as much as I have witnessed crumbling health systems, I have also witnessed political will, harnessing of philanthropic interest, a new energy to change things, make things that exist better.  And I firmly believe that where there’s a will, there’s a way.  And not only that, but that we can do it with kindness.  That we can smile.  And we can make mental health – for everyone – matter.  Be part of those who support us as opposed to those who don’t. I am 4 M’s Bipolar Mom.

Mental Health Detective Report Back

There I was, I had planned my trip to the PRIMARY HEALTHCARE Clinic.  The Government Service.  The supposed to be free one.  The one in AFRICA one.  You would be forgiven for imaginging lions and elephants trawling about the yards of the clinic, because if that were true, it would simply capacitate you to function BETTER in the system.  A) If you’d been mauled, you would get pushed up the queue (and be taken more seriously than JUST a chronic mental illness) and B) You’d have a “funny” story to tell an otherwise disinterested and very tired, healthworker.  And whilst there aren’t lions and elephants serving as gate keepers to mental health services, there are many other um, hairy hindrances that do.

In the country that I live in, the first challenge that we confront is that there are far, far too few psychiatrists in practice, particularly in the public health sector.  It takes weeks / months to access a psychiatrist in the public sector, which is in fact life-threatening for a person with chronic mental illness.   Now I’m well aware that medication is not the only thing a person with mental illness requires, but in my case (and I recommend this) it’s a huge part.  Not being able to see a doctor that could give you medication.  Well, the mind boggles.  Thereafter the other very real reality is that there will be medication stockouts, or that the medication you are on is not seen as ‘necessary’ by Government.  For example they think that some anti-depressants aren’t necessary.  Grimace.

But before I complain about the shortcomings of the health system,  the very real challenge – and the reason why I ended up NOT going – is the horrible, disabling stigma that exists in our communities and which in my case – and I’m sure many others – results in the worst form of stigma:  believing what people tell you about you.  You see even if I had jumped the hurdles of waiting forever, expecting to have to come back for appointments numerous times, I was most worried about what each tier of the public healthcare system would require of me:  telling “the story” that informed my diagnosis. Having to “speak up” and contend with much “and how did that make you feel” is both frustrating but also heartbreaking to have to recall and retell – again and again and again. Honestly, being a slightly clever girl, one would have thought that I would have taped the “how did I get crazy” convo by now, so I could just press play and have the healthworker informed.  But funnily enough, each time I’ve needed to outline the top ten reasons why I’m mentally ill, I haven’t had the candour or humour to record it.

So the truth is that this mental health detective went as far as playing out going to the clinic in her mind, and retreated immediately to the couch to eat the snacks she had packed for the trip (and as many others as she could carry in a single trip from kitchen to couch, but hey who’s counting).  Oh, and she may have had a little cry, an anxiety tab or two, and a nap. Because I don’t want to do that right now.  Explore how broken I am in order to be slightly fixed with medication I may only get six weeks  / months later thing.  No thanks.  I’m an expert in roasting myself, I don’t need help or reminders of the cracks and creaks my being holds or has a lack of.  This is the coward way out, I know, I am paying for medication I can’t afford, but am too chicken to attain from the Government Service.  Ok, I will work on going to the Government Service.  I think I may try and convince myself that I’m doing a public service so I can feel heroic about it.  Ok, a couple levels lower than heroic, but a lot levels higher than chicken.  Be part of those who support us as opposed to those who don’t.  I am 4 M’s Bipolar Mom.