Sunday, November 7, 2010

How to get somebody to consult a psychiatrist

Some excerpts (reproduced with permission) from responses to my last post.

"My Dad was a closet alcoholic"
"...asking for help on alcohol consumption for my friend's son who will soon turn 19 years...parents now try to monitor his timings, where he is but he is slippery and generally seems to be ahead of them."
People may know that a loved one requires help with an alcohol habit or other behavioural or emotional problem. The reluctance to seek help is mainly due to the stigma attached and the individuals lack of insight (blindness to the presence of the illness). How does the family or society (a neighbour) get the person to a psychiatrist or other mental health professional?

Individual choice and potential for harm are in the balance
I've listed out some methods  - by no means exhaustive - used successfully by other caregivers. They are in descending order of individual choice and autonomy. Use your discretion.

How to get a person to consult a psychiatrist

  • Talk to the person then hold them to their word. If the person asks for 'another chance', get an undertaking for consultation if the problem recurs.
  • If the problem is with a child talk it over with the person who can veto the consultation (your spouse, your mother-in-law). The child will exploit any lack of consensus.
  • Put across the consultation as a confidential discussion with a neutral person.
  • Focus on the physical complaints - sleeplessness, loss of appetite, fatigue. Fix a consultation for these "stress related problems".
  • Seek help from a person they trust. This may be an uncle, a grandparent or daughter-in-law who may not be aware of the problem but would be willing to intervene for the benefit of their loved one.
  • Get the family physician to refer. Physicians may prefer not to go in for a discussion on the need for psychiatric referral. Letting the physician know in advance will facilitate referral.
  • Use coercion. If the person is still refusing to consider an evaluation threaten withdrawal of some support for which they are dependent on you (you should be prepared to follow through on this). Play on their insecurities (eg. to divulge information to a colleague or boss).
  • If there is any kind of self-harm be firm and seek an urgent consultation
  • In case of escalations with violence and agitation seek admission to a mental health centre. There are provisions for this under the Mental Health Act.
Remember, untreated psychiatric illness will increase stigma

Wednesday, October 13, 2010

Why would a mother burn her daughter?

A family tragedy was played out through a small article in the Pune news. In a fit of rage a mentally ill woman set her daughter alight while she was asleep. The narrative was short and the item tucked into one of the inner pages under a largish headline.
 This was the reason - the why - mental illness
World Health Report 2001
 A glib explanation for a horrific event lays the entire burden of its causation at the doors of a mental health disorder. The World Health Organisation  (WHO) has estimated that one in four persons will have a mental health disorder at some stage of life .

Violence is rarely a manifestation of mental illness
In this rare cause of burning (mental illness), the burning of her daughter is an indicator of the severity of the mother's mental illness. Yet society, of which this news item is a barometer, has unquestioningly accepted mental illness as a sufficient cause. In a nation with about 0.48 mental health workers of any kind  for every 100,000 people, a woman who had previously managed to access mental health care slips through the organisational net and goes on to seriously injure her own daughter. A family that had against overwhelming odds obtained mental health care for a loved one could not mobilise the resources to access it again when her illness escalated. Ease of access to mental health care is crucial. Why?
Common mental illnesses are effectively treated with medication
Most people with mental illness achieve control over their behaviour and impulses. The cost of treatment with standard and effective medication is less than Rs5-10/day. The social costs of mental illness is the major barrier, keeping those needing care from seeking it. The other barrier is institutional, keeping those seeking care from getting it. This mother could not cut through the social and institutional barriers to obtain that care. That is why a mother burnt her daughter.