I arrived at Mum’s at 9.15am. This visitor was always early. Her first visits were time-tabled for 9.30 am, but she would take us in on her way to work, and so would get there for 9.00 am. This time I had asked her to come at 10am, to give Mum and me a chance to get going in the morning: we assumed she would be half an hour early but this at least gave us till 9.30 am. This particular morning she had really outclassed herself, and was there by 8.45. She is one tricky lady.
When I got in, she was perched on a low stool next to mum’s chair, holding her hand.
“Hello,” I said, “Nice to see you. I thought I would get here before you this morning! Wow! Your hair looks different!”.
“Yes, what do you think?”, She said, patting it, and looking me straight in the eye.”Do you like it?”.
“Yes, of course, it’s very…….Bright.”, I said, “Cheerful.”.
“Well, party season coming up!”, she smiled.
A smart dresser, great shoes, and handbags, and now, in your face blonde hair.
She is Mum’s psychiatrist. This is her third six monthly visit.
“I always try to get to home appointments before I am expected, you know. I like to catch people slightly on the hop so I can tell what’s really going on.”
Mum had been under the care of the NHS Mental Health Team since 1969 when she had her first breakdown.
On Mum’s six monthly reviews, and occasional forays into admittance, which took place at the hospital, her previous psychiatrist had just sat and listened and prescribed medication. He had seemed, according to Mum and Dad, inert, depressed. They had requested a change, and this one was active. Personable, involved, empathetic, she made Mum feel as though she mattered. On her first visit she said there was very little in the notes about Mum’s life history, and we tried to make sense of life events, genetic predisposition, and the resulting illness.
Narratives are good. Nightmares should be made to make sense.
On that first visit I tried my best to get her to take Mum in, to get her sectioned. She was being a nightmare to Dad, who was so ill. But she laughed: there were twenty, thirty, people, far more psychotic than Mum, and she did not have beds for them. The mental hospitals were full. Funding had been cut.
This link shows how it had been cut by 8% since 2010, while demand was rising fast.
My poor parents did not stand a chance. Mental Health Service Cuts are Madness.
That year was so miserable for them both. Tragic life events have a catastrophic effect on psychosis: paranoia feeds off life’s emergencies like a parasite.
On that first visit Mum’s lovely new psychiatrist would not section her but she did change her prescription. This was really quite disastrous: mum started to slow down considerably and become more prone to falls. Another medication was added in hospital after an investigation into why mum was falling; she was diagnosed with vertigo and the pill prescribed had the serendipitous effect of calming the paranoia. I noticed this and later we removed the psychiatrist’s medication. In the medication department our psychiatrist had been unsuccessful.
On her second visit, after Dad’s death, when Mum was achieving an equilibrium again, our lovely new psychiatrist said she was thinking about discharging us. There were more cuts, she had a huge load of patients, and they were nearly all more acute than Mum. Look how well Mum was now!
“She is still paranoid,” I had protested.
“Well, I can up her dose, but that would reduce her mobility again.”.
“I really can’t have that, I can put up with the paranoia, just please keep us on your books.”.
“Well let’s see how she is in six months.”.
So here we are, the third visit, six months later. Mum is less paranoid, but still paranoid. She rarely mentions to me her conviction that “the Bag” was sliding in past the security cameras that I had installed to show her that no such person had been in through the doors, but she did to others, including the psychiatrist, who of course asked her.
The psychiatrist asks me how I felt now, about Mum coming off her register.
I start to cry. I explained how isolated I feel, how unsupported, how scared, how much I relied on her unit just to be there. Even if they do not do very much for us, and prescribed the wrong pills, they have been a constant. We, or rather I, really did need the psychiatrist and the mental health nurse.
The psychiatrist is clever. She points out that my family, my husband, sons, cousins, aunts, uncles, neighbours are supportive. I have a sister. And Mum is getting more stable.
I find myself starting to agree with her.
Yes I did know a huge amount about Mum’s medication now, and yes I was resourceful, I was the one who had noticed and managed the change in medication, Mum was doing well, ………and yet ………..this was all at huge personal cost.
I had had to give up a job I had loved because I could not cope.
Even now, I am and am not coping. I am and am not supported: yes my own family are good, but this sister who should be sharing this responsibility won’t. I should have respite and none was offered.
I am proud that I am supporting Mum to live in her in her own home, and despair that this is a house of cards that could blow down at any time. I am running two houses; maintenance, bills, meals, washing…… often badly.
That bloody dog, who is lying adoringly at the feet of his psychiatrist, is the bane of my life, and the love of my mother’s.
“Lovely dog!”, the psychiatrist says, and ruffled his good ear, the one without the weird skin condition. I had given him a bath, in the bath the day before, and his good skin was in silky condition. He damn near purred.
And then she says Mum was one of her most stable, best supported, happiest clients. She herself was very happy to come round once every six months to have a chat, a cup of tea, and Mum spoke more to her about her family, her grandchildren, the dog, than about her paranoia, which was lovely. She says ‘lovely’ a lot, which is lovely. Our psychiatrist had hundreds of clients who needed her so much more than Mum did.
Although once every six months for an hour or so did not seem very much to us, there were people, really desperate people, who needed her more.
I start to feel sorry for the desperate people. There is a rising demand and a smaller budget. My sense of fiscal responsibility is fairly high and I feel guilty. It is not Mum who needed this psychiatrist, it is me. I break out in a sweat of cognitive dissidence.
Mum says it’s always nice to see her but she didn’t need her at all. This is not a surprise because Mum has always stoutly maintained that we are mad, and she is not.
I give in.
It makes perfect sense now to me that my psychiatrist should sign us off, and she is going to complete the paperwork in a few weeks. We will get one more visit from the mental health nurse.
I am going to be abandoned by the Mental Health Services.
I say good-bye for the last time, as she sashays down the garden path in her harmonious outfit, and anchor butter coloured hair.