This week, we rebroadcast our show from last season on the treatment people like me give patients with mental health problems.  According to the Public Health Agency of Canada, one in five Canadians will experience a mental illness at least once in their lifetime. With those kinds of numbers, you'd think we'd be better at caring for them. Unfortunately, that's just not the case. Some of my emergency colleagues drop by to talk about how frustrated and fearful they get when psychiatric patients walk in the door.

For a rebroadcast, the show received quite a strong reaction from some of you.  Click on the link below to read your emails.

Being identified as a current or ex-psychiatric patient can be extremely stigmatizing in our society.  For that reason, we have chosen to withhold the name of anyone (including family members) who recounted personal experiences with the mental health system.

"I commend you for being brave enough to look into this issue of how mental health is seen by emergency doctors.   I myself have a mild form or Bipolar Affective Disorder and have never needed to be hospitalized for it, but I do know that when people are having disturbances in the mental flow, it's not something they themselves are really able to control.

"I was rather disappointed by the fact that the psychiatric doctor that you interviewed did not stress this particular thought.   She said, "Oh they are trying to get attention" but did not go on to say WHY it is that these people ARE trying to get attention.   It's not just a "look at me" act.  They are sometimes calling out for help and have never learned the skills with which to ask in any other way.

"I was also disturbed greatly by your comment about the room in which they placed people to calm down.  Your comment was something to the effect of, "How long do they typically stay in there until they get the point?"  Proving without a doubt you had not gotten the point yourself. It's not a matter of getting a point; it's a matter of them being free of outside stimuli that agitates them to the point of breaking.

"I seriously wish that doctors would all have to be trained in mental illnesses, as you said, 1 in 5 have a chance to have at least one break in their mental health at some point in their lives.  We all need to learn more tolerance and see that just because there aren't any physical symptoms to "patch up" that these people are nonetheless ill.  We, the mentally ill, need more help.

"Your Mental Heath Show was a start, but I think it could have been much more enlightening than it was.  Thank you for taking the time to read my comments."

From:  Name withheld

This email deserves a reply.  I do not believe that seclusion should be used to make a point.  The premise behind White Coat, Black Art is to capture the unguarded comments of people who work inside medicine's sliding doors and then let people judge what they have heard.  If you believe I should have challenged the psychiatrist, that's a fair point.  But do not assume I was agreeing with the comment about making a point.  Thank you for your comments.

"I am an adult in my late 20s who grew up with a mother and father who seemed to have various mental health issues that have never been clinically assessed or actually diagnosed with any mental health issues.  Both are compulsive hoarders and alcoholics and appear (from my armchair psychologist's, well, armchair,) to have symptoms of personality disorders such as obsessive-compulsive personality disorder and narcissistic personality disorder. I spent my childhood in a filthy, cluttered, dysfunctional environment.

"I got away from that situation as soon as I could and have had limited (and, for a while now, zero,) contact with my relatives in nearly ten years. But I still, rightly or wrongly, sometimes worry about being stigmatized myself for having relatives with mental health problems.   I'm not just referring to social or workplace situations, but also, and especially, to dealing with medical professionals such as doctors.  When, for example, I see a new doctor and that doctor is taking my medical history, I don't mention my relatives' mental health issues or my childhood. I don't want a doctor to think that, because I have mentally ill relatives, I'm genetically or environmentally doomed to be mentally ill myself.  I don't want that stigma hanging over me. And I don't want it to change the way that health care providers treat or communicate with me. What are your thoughts on this, Dr. Goldman?"

From:  Name withheld

I am sorry that you had such a difficult upbringing.  At the same time, I sense that you have grown up well because you have been able to separate yourself from the issues that your parents faced and likely still face.  You have also developed a commendable ability to reflect on how your parents' behaviour impacted on you and your upbringing. 

I can understand why you might feel reluctant to reveal to a health professional the situation in which you were raised.  I do hope you change your mind on this.  If you seek help, it's only in your best interest to be able to confide in them so they can better help you.
I wish you the best.

"I was appalled to hear parts of your recent show on mental health patients in the ER. As a person suffering from Bipolar Affective Disorder, I face overwhelming fear of judgement, mostly due to misinformation, or sensationalized presentation of information, in the media.  I was most disappointed to hear discussion of theatrical antics to seek attention, being equated to mental illness, and essentially a toddler's temper tantrum.  So if I now enter an ER with a kidney stone, how much longer do I need to suffer to prove I'm not throwing a tantrum for attention?  If I were experiencing hypomania, my thoughts, and reactions to them, could be beyond my control.  Before you think of this as an excuse for terrible behaviour, think of how terrifying it would be for this to happen to you, and what kind of urgent treatment you would need. I truly hope better education and protocols, to help deal with difficult and/or violent patients, whether or not they suffer from mental illness, can be implemented in the ERs discussed.  After all, it's best for everyone to get the help they truly need, in a timely manner, and a safe environment.

"There is a tremendous stigma in our society towards current and ex-psychiatric patients.  For that reason, we have decided to withhold the names of those who contributed stories of their own experiences in the mental health care system."

From:  Name withheld

"I was surprised to hear your description of a mental health patient presenting in Emergency, in terms that made me think you are suffering from anti-mental health bias even now.   Using words such as 'berserk' conjures an image of patients frequently presenting as dangerous to hospital, while in fact by the time they get to the ER, their behavioural difficulties are mostly constrained.   While staff in the two B.C. hospital emergency departments where I worked as a psychiatric social worker are highly trained in safety precaution measures, many patients who present to emergency in mental health crisis have a chronic illness that has flared up and needs treatment; they are, frankly, rarely 'berserk'.

From:  Chris Whyte, Vancouver

Fair points, Chris.

"Dr. Goldman, thank you for all you do.  I listened to much of your recent show and have a couple of suggestions on how to accomplish the goal.  First, if the police determine that someone on the street is in need of psychiatric services, then a psychiatrist should be dispatched to the site to do an interview and determine the next appropriate step.  Second, if the next step means going to the psychiatric ward for an out-patient or in-patient evaluation, then the individual could go directly to that ward and bypass the emergency room administrative procedures.  The police and/or the EMS staff could complete appropriate paperwork for the emergency room.  Third, if this way of helping street people get psychiatric services could be tried, I'm sure it would be easy to determine the cost savings of having police and other units spend numerous unproductive and frustrating hours.  Finally, before the individual is brought to the hospital, it would probably be better if a local agency could be available to clean and bathe them and if necessary provide fresh clothing for them.  If these steps were taken, I think hospital personnel would be more amenable to having patients with mental health issues in their midst.  Hope this helps."

From:  Jeff Salmon

Jeff, your suggestions were helpful.

Many of you commented on my tour of the Archie Courtnall Centre at the Royal Jubilee Hospital in Victoria, British Columbia.

"Evidently, the way we treat the mental patients in Canada is inadequate.  A few months ago, while waiting for a stretcher in the ER of a hospital in British Columbia for treatment of a broken wrist, I witnessed police interview of a stabbing victim.  He was knifed by a family member.  The victim found the professional intervention he sought for his family member in the past was both limited and ineffective.  An emergency room designed especially for mental health patients would be a logical place to care them. "

From:  E. Wen

"Regarding ERs, would it not make some sense to have at least one nurse in every ER who is specifically trained in psychiatric nursing to deal with those kinds of patients and be able to better identify them?

From:  Eric Penel, Edmonton

Yes it would.

And finally, we received this email from Elizabeth Pogue of Sooke, British Columbia. 
"I was listening to your piece on the Archie Courtnall Centre.  At the same time, I was reading Avalon Roberts's piece in the Victoria Times Colonist. Two very different angles on the same topic."

Elizabeth, you aren't the only one to raise the fact that the Times Colonist has been running a series of articles on problems in the care of patients with mental health issues at the Archie Courtnall Centre and elsewhere in the province.  Thank you for bringing this and other stories to our attention.  This is an issue we hope to return to this fall on White Coat, Black Art. 

Thanks again to all of you for your contributions.