For overseas readers, Australia has been shocked by an incident in a shopping centre in Sydney where a 40yo man with a long history of schizophrenia stabbed six people to death and injured another dozen before he was shot dead by police. There was apparently no warning but he had been moving around between New South Wales and Queensland, where his parents live, and had been living in his car at times, so there is a suggestion he had stopped his drugs.
This comes from a semi-retired psychiatrist with half a century of experience at the rough end of psychiatry:
McLaren:
‘ …but nothing will come from it apart from the usual calls to spend more money on keeping more people detained in hospitals longer and on more drugs. … My limited experience of them is that they are a total racket, allowing well-heeled psychiatrists to fleece patients, governments and insurers providing "treatment" for people who, overwhelmingly, could be managed as out-patients, if they need anything at all.’
Stampfer:
I have long been banging the table to say that at least 80% of inpatients at any time could have been treated as outpatients, only to see nothing change. However, I don’t think the persistence of the trend can be attributed solely, of even mainly, to psychiatrist self-interest. It is very much a two-sided arrangement/collusion between psychiatrist and patient, both in the public and private sector. Things have changed a lot since the time we started out training. Back then patients wanted to sue shrinks for detaining them, today they want to sue them for discharging them!
Discharging patients has become a stressful and problematical matter. Patients will openly say, ‘you discharge me, and I will commit suicide and name you in my suicide note’. Fear of adverse outcomes, whether deliberate or by misadventure, has made psychiatrists not infrequently seek a second opinion about discharging someone and I have been asked to provide such an opinion on several occasions. Some patients have had to be literally evicted from the ward with the help of security guards.
Family members are often worse than patients when it comes to discharge. Parents and other family members have not infrequently lodged formal complaints about someone in the family being discharged too soon. Too many parents want their wayward children hospitalized for at least one year … to stop them taking drugs! Parents recently reported me to ahpra for discharging their drug-taking son too soon, even though there was no justification for detaining him. Thankfully nothing came of it but I’m sure you would understand how the paperwork involved in having to justify my decision, caused me to suffer an emotionally driven bowel movement.
Not only do patients want to remain in hospital far longer than can ever be justified (and for obvious reasons) but far too many insist in being maintained on their largely useless medications – because taking them helps to define the severity of their illness and need to remain in hospital! I have on many occasions persuaded patients to come off their useless medications when they were inpatients, only to discover they were back on the very same medications and often a few more, when they returned to outpatient follow-up.
My bottom line is that it’s not just greedy, self-serving shrinks - patients and their relatives contribute at least equally in perpetuating unnecessary inpatient treatment and persistence with ineffective medication that only achieves side effects.
This comes from a semi-retired psychiatrist with half a century of experience at the rough end of psychiatry:
McLaren:
‘ …but nothing will come from it apart from the usual calls to spend more money on keeping more people detained in hospitals longer and on more drugs. … My limited experience of them is that they are a total racket, allowing well-heeled psychiatrists to fleece patients, governments and insurers providing "treatment" for people who, overwhelmingly, could be managed as out-patients, if they need anything at all.’
Stampfer:
I have long been banging the table to say that at least 80% of inpatients at any time could have been treated as outpatients, only to see nothing change. However, I don’t think the persistence of the trend can be attributed solely, of even mainly, to psychiatrist self-interest. It is very much a two-sided arrangement/collusion between psychiatrist and patient, both in the public and private sector. Things have changed a lot since the time we started out training. Back then patients wanted to sue shrinks for detaining them, today they want to sue them for discharging them!
Discharging patients has become a stressful and problematical matter. Patients will openly say, ‘you discharge me, and I will commit suicide and name you in my suicide note’. Fear of adverse outcomes, whether deliberate or by misadventure, has made psychiatrists not infrequently seek a second opinion about discharging someone and I have been asked to provide such an opinion on several occasions. Some patients have had to be literally evicted from the ward with the help of security guards.
Family members are often worse than patients when it comes to discharge. Parents and other family members have not infrequently lodged formal complaints about someone in the family being discharged too soon. Too many parents want their wayward children hospitalized for at least one year … to stop them taking drugs! Parents recently reported me to ahpra for discharging their drug-taking son too soon, even though there was no justification for detaining him. Thankfully nothing came of it but I’m sure you would understand how the paperwork involved in having to justify my decision, caused me to suffer an emotionally driven bowel movement.
Not only do patients want to remain in hospital far longer than can ever be justified (and for obvious reasons) but far too many insist in being maintained on their largely useless medications – because taking them helps to define the severity of their illness and need to remain in hospital! I have on many occasions persuaded patients to come off their useless medications when they were inpatients, only to discover they were back on the very same medications and often a few more, when they returned to outpatient follow-up.
My bottom line is that it’s not just greedy, self-serving shrinks - patients and their relatives contribute at least equally in perpetuating unnecessary inpatient treatment and persistence with ineffective medication that only achieves side effects.
Andrew Amos is bravely writing some interesting stuff about psychiatry in Aus in relation to the transition of children and prescribing puberty blockers and hormones. It great to see someone in the profession finally speaking up about this. Have you read the Cass review? Would be interested to hear your https://open.substack.com/pub/freudsrazor/p/madness-and-gender-medicine-boundaries?r=16o8fg&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true