Rural Mental Health 911

There I was, minding my own mental health business when someone I know (read my husband of the last 20 years who is growing on me) suggested I travel with him through rural South Africa.  He is doing a review on the state of rural health, whether there are sufficient doctors, nurses and other necessary stuff for health to be delivered in a context where everyone – let alone people with mental health challenges – are vulnerable.  At first I wondered why on earth he would want me, the multiple mental illness disordered someone to travel with him, as I’m not really the kind of gal you can take pretty much anywhere (and who has consistent unreasonable demands that cannot be met).  For example, I was completely outraged that they did not have a cappucino (extra shot of espresso with cream) at a petrol station in the very rural parts of the Eastern Cape Province of South Africa.  I mean honestly, rural health is a challenge, but no proper coffee?  This could lead to war and I am the most concerned for these coffee poor people. Anyone with mental illness within a 500 km radius is clearly suffering – if you can’t get over your pill hangover with proper coffee what can you do??

More seriously what struck me was a number of stark, non mental health friendly realities that exist in this environment.   Firstly (in no order of priority):  everything is FAR (like really far) and that means that healthcare (regardless of the reason) is difficult if not impossible to access.  If I think about the times that I needed to go to hospital, urgently (cryingly / psychotically etc) needed to see my psychiatrist / psychologist, the mind boggles at how you would access these kinds of services in rural areas in Africa when you are EXTREMELY vulnerable. Second:  I know for a fact (and it’s confirmed by research) that mental health / illness awareness is low if non-existent.  Coupled with this, as we all know, there are also many mental illnesses where insight into your own illness is low (and most likely to be some of the most severe illnesses).  Thirdly:  even when you know you’ve I dunno, felt sad and manic your whole life, and would like treatment, you are likely to be made to feel worse by way of reception from your local family / community / health workers (or all of the above) whom you may or may not be able to access after travelling loads of km’s with money or food that is in very, very short supply.

And then my personal favourite:  let’s assume you’ve been able to jump all these hurdles: if you need to be hospitalised, a “bed” is usually on a first come about to die basis, so if you’re not in the act of death and / or dying there usually isn’t a bed,  an actual psychiatrist on call, or available, approriate medication to treat you with what is often considered to be a rather minor, made-up ailment.   I have personally been told on admitting that I was suicidal and needed hospitalisation that I should come back later.  Insert witty comment here, as I have no words.  This was certainly my experience in urban areas, so I imagine that in rural areas, this must be very, very much worse.  Added to this, Emergency Medical Services in the Province has been known to go on STRIKE.  Yes.  All available ambulances were on a um, go slow.

If I lived here, I would participate in the strike and my own mental health by asking them to put me out to pasture with the cows, and hope that I be struck with lightening as a manner to reset my clearly broken brain and body.  Better than waking up without coffee, to have to walk / hike far to a facility that would be too full, or to be “turned away” by an ambulance that wasn’t working that day.  Am I making fun of this situation?  What would I suggest in this deplorable state of affairs?  I really don’t know.  I don’t know how many people with mental illness live here, what they need, and how we can help and make sure that things change.  After all – we live in the country with one of the most enabling constitutions in the whole world – and further rights that are enshrined in our bill of rights.  Unfortunately though – in the past couple of days, I have seen that this means very little if anything – to people who don’t even have their basic human rights respected, let alone access to health.  We need help, we need to make a noise, and not stop until it changes.  And YOU need to be part of it. African Mental Health Matters Too!  Be part of those who support us as opposed to those who don’t.  I 4 M’s Bipolar Mom.

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.