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

2 comments:

  1. It reminds me, how another Psychiatrist friend of mine, helped me change my perspective about 'Alcoholism' - a social stigma, disdained by me. He said that treat it like any other illness, and treat the person, as you would care for a patient. That stuck - a changed attitude in primary care settings helped me lend my ears where needed, and refer to the Psychiatrist those who needed/sought help.

    Only if the society at large adapts an attitude that psychiatric problems are but 'illnesses of the Mind' and we need to care for the suffering one - we would render a great help to the sufferer...

    Thanks Neville, for helping people evolve their understanding about psychiatric illnesses.

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  2. Sanjiv we all need to apply the science to our doctor-patient interactions. At times this would mean putting our own attitudes and beliefs on the backburner or possibly changing them - as you did :)

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