By Marvin Ross
Recently, I reviewed a book manuscript from a woman who had developed bipolar disorder in her 40s and had been hospitalized a number of times. What I found particularly interesting was that the woman had originally been trained as a nurse although she was not working in that capacity. She said that as a student nurse, she and her fellow students hated their rotation on the psychiatric ward. She admitted that she and the other students had disdain for the patients and that they felt that their illness was their own fault.
I don’t know how many of those student nurses ended up working with the mentally ill nor do I know if those attitudes are held by the majority who work in this area. And, while I recognize that there are many kind and compassionate people working with the mentally ill, I’ve found from personal experience and from what others have told me that there are still far too many who display the same attitudes as those student nurses. Is it the attitudes they came into the field with or is it burnout? I don’t know. These are but some examples reflecting attitudes between those who do work with the mentally ill and those professionals who only come in contact with them periodically.
A young man with schizophrenia had been going to a very nice community dentist who left his practice and so he asked his psychiatric case worker to recommend one. He was sent to a dentist who looked after many of the clients of this particular agency and the dentist was rude, impolite and suggested that this individual needed to have a number of teeth extracted. He complained to his caseworker and was told that many clients complained about this dentist but they had no one else they could recommend.
I referred the individual to another community dentist who saw no need to extract any teeth, was aware that his new patient had schizophrenia and bent over backwards to provide caring and compassionate service.
Now because this person is on clozapine, it requires regular blood monitoring to ensure that the white blood cells are not being depleted – a serious side effect of this particular anti-psychotic. The agency has all its clients go to one blood lab which is not convenient for many of them who do not live near the lab. The agency refused to allow any client to have their blood taken at other labs and argued that only this particular lab could do the job as they specialized in clozapine blood work.
That was absurd as the blood work is for a white blood cell count which is a common and standard test. In fact, the blood labs that take the samples do not do the analysis as the samples are sent to a central laboratory. The real issue was that the staff of the psychiatric agency could not be bothered to write up a separate requisition for each client who wanted to go to a more convenient lab. I suspect that they had one requisition and just sent in a long list of names of clients who required the test.
When this individual went to another case management agency, the staff expressed surprise that he was only allowed to go to one inconvenient blood lab and gave him a requisition that he took to a lab withing a short walk of his home.
And, outside of the psychiatric hospital pharmacy, only one drug store dispensed clozapine so clients from that agency had to have all their prescriptions dispensed by that one pharmacy. And the staff at that pharmacy were completely rude to their customers which I observed on a number of occasions myself. Again, the new agency arranged to have the clozapine dispensed by the hospital pharmacy so the individual could take his other prescriptions to a more convenient community pharmacy. He was quite tense about the move and tremendously relieved to find that the new pharmacy was efficient and treated him with respect.
A number of years ago, I did a short piece called a Tale of Two Systems where I compared the care given to a man with schizophrenia between a specialized psychiatric group home and a residence for seniors. The relatives could not believe how much better care and respect the man received from a seniors home than he got from the psychiatric facility. In fact, the mental health staff ignored what were obvious signs of developing Parkinson’s until the poor man broke his hip, developed pneumonia and ended up in a seniors home. And the relatives got much more information from the staff. They did not hide behind privacy as an excuse to ignore the family as often happens in psychiatric facilities.
Katherine Flannery Dering describes a similar situation in her book Shot in the Head A Sister’s Memoir, A Brother’s Struggle about her late brother Paul. Hospital staff in the psychiatric stream noted and ignored a tumour on Paul’s lung. It was only when the family moved him into a seniors residence that the doctor also noted the existence of the tumour on his lung, had it biopsied and discovered lung cancer.
People with schizophrenia have a life expectancy that is about 20% less than others. Part of this stems from the condition itself but studies have also shown that assessment and treatment of common physical health problems in people with schizophrenia falls well below acceptable standards.
Now, I realize that It is not easy dealing with people who can be difficult and frustrating to work with because of the very nature of their illnesses. I get that but management should be better attuned to burnout if these attitudes stem from that and should develop strategies to deal with it.
I’d love to hear from others if what I’ve observed is as common as I’ve noticed and some ideas that might help burned out staff to deal with their problems.