The night the Black Dog caught up

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That damned depression. That damned Black Dog.
'I just want to be normal.' It's not a big ask, is it?
That damned depression — wouldn't wish it on my worst enemy.
It squeezes the life out of you; makes you feel like an outsider —
Outside the game of life that 'normal' people seem to play so well.

Our friend's not doing so well. The normalcy she craves has left and gone away. There's now a chasm between her and the game of life.

The Black Dog has caught up with her. Not surprising, mind you; it's been chasing her for 20-odd years.

Woman watches TV, giant black dog sits in backgroundShe got tired; couldn't run anymore. Nothing left. So up to the emergency department doors she went: 'Doctor, nurse ... anyone, I can't run anymore. The Black Dog's too fast, too strong. I'm worn out — just want to be normal.'

They heard her ... sort of. Into a tiny room she was sent ... to wait.

To wait to be seen by someone; someone with expertise, someone who 'gets it'; someone I can see and smell and shake hands with, please.

It was a pretty long wait, not because the psychiatrist and other mental health professionals were too busy that night, but because there weren't any on deck.

That's the norm these days ... the local mental health system has adopted a new model of care.

It's a crisis centred approach; reactive rather than preventative.

More a nine to five system too; a lot less expensive — not that money has anything to do with the cut backs. This is a 'better model'.

The wait's over for our friend. Into another room she goes to be greeted by a big television screen beaming-in the face of a distant expert: there'll be no human contact with mental health professionals this night; no shaking of hands.

It's a shame, really, because this isn't a fair reflection of the local mental health team stationed on the ground. They're a compassionate, committed group of professionals. But, like the talented busker who has been tossed an extra 12 balls to juggle in the middle of his act, things get dropped.

We are asking too much from too few — and it's people, not balls, that are being dropped.

The consultation with the TV screen expert is underway — it's not easy conversing with a screen when you're desperately ill; isolated and alone. Perhaps the expert also finds it hard. She also cares, no doubt. It's just that the system is slowly but surely stripping itself of its humanity.

Seems to be a common theme these days: screens and things replacing people.

'Why don't you talk to your GP,' says the expert from an unknown destination.

Don't tell the GPs that. They're sick of being used as default 'psychiatrists' cum 'case workers' for the mental health system. As if they haven't got enough on their plates. More and more, their clinics are awash with people set adrift by a poorly designed system.

Many believe awareness around mental health is at an all-time high; it probably is. But things on the ground remain pretty dire despite the heroics of some being forced to juggle more and more.

Our friend's TV screen consultation is over; exhausted, she walks back home on her own. It's midnight.

More phone calls the following day; this is serious. Our friend's still not doing so well.

Thankfully, members of local mental health team take up the baton — ever prepared to take it that extra mile. Things are starting to happen. But our friend also happens to be well connected: that is, she is surrounded by people who can navigate the system. Too many others can't.

Don't be fooled by politicians and bureaucrats holding umbrellas; the mental health landscape in NSW and the ACT — indeed, throughout the nation — is in severe drought. It is a system bereft of love and humanity; bereft of a coordinated, person-centred vision.

As the Federal Mental Health Commission said in its 2014 national review Contributing Lives, Thriving Communities: 'It is clear the mental health system has fundamental structural shortcomings. This same conclusion has been reached by numerous other independent and governmental reviews.

'Stigma persists; people have a poor experience of care. The system doesn't prioritise people's needs, responds too late, is fragmented, and does not see the whole person.'

Our friend is still not doing so well. She says she needs patience and time and people; she says love works too.

She also says it's important to be treated as a person rather than an illness.

Now there's a good framework for a national model of mental health care.

How's your friend doing?

 


Peter DayPeter Day is the founder of HOME in Queanbeyan, which provides 24 hour supported accommodation for 19 men and women with enduring mental illness.

Original artwork by Chris Johnston

 

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Topic tags: Brian Doyle, mental health, depression

 

 

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Existing comments

Beautifully written Devastatingly true Painfully real I hear the hype on Mental health- it has been "discovered" but like the author just try getting help for a friend whose black dog is biting bad. Hospital wait rooms for hours- GPs booked out- how to get on the mental merry go around- join the referral ragtime- on and on you go- too old for this service wrong location for that service. If your friend has not thrown himself in front of a train or is not standing on a bridge ready to jump- no one can act.
Pamela | 08 March 2016


I know the case of a man who consulted his GP, was referred to a psychiatrist, got a $350 bill (only have covered by Medicare), then eventually referred back to a clinical nurse consultant who managed a hospital mental health unit where he'd been 2 years previously and given a brochure on "practising mindfulness". The nurse he was referred to inquired why he could go back to the psychiatrist, then suggest seeing another GP She suggested this "mental health unit" would have no psychologist or psychiatrists available for appointments in the next few weeks.
MIKA | 08 March 2016


Thanks Peter. Incisive and compassionate.
Frank | 09 March 2016


Very true here too. Please treat people with love and care despite that feeling you cannot help. Treat them as you would others. Every family has its sufferers with the black dog.
Noeline Champion | 09 March 2016


I do not have a mental illness, but I have been in very close contact with mental health services in the ACT for about forty years. Recent experiences of people that I know well suggest that care for people with chronic severe illnesses is the worst it has ever been. I know that such illnesses are very complex and the context in which they occur are also complex; I am aware as well of recent developments in the research area. Practice on the ground, however, unfortunately, seems to be driven by unhelpful fads. As for raised awareness in the public arena, the stigmatising myths about schizophrenia still abound.
Sheelah | 09 March 2016


Sadly the Australian mental health system is crisis centred and more often than not based on shorter term therapies coupled with medication. Longer term work such as psychoanalytic psychotherapy with the possibility of sustained interpersonal interventions with the one therapist does not make it into the arena. Evidence for the effectiveness of long term ( 2 years of weekly) psychodynamic psychotherapy was published last November and, I daresay, further studies are in the pipeline. This has resulted in an important debate in the Guardian about the contribution of this modality to treatment and the need for it to be respected. All too often experienced practitioners have had to defend their work despite clear evidence that it does work, because evidence for it is not formulated in scientific terms. And of course there are questions about its expense. Interestingly the fact that people can and do respond to long term treatment, often enough in Australia provided by a psychiatrist, and go on to make effective economic and social contributions is overlooked.
Christine | 09 March 2016


How beautifully written. I have a horrible feeling it will fall on deaf ears.
Bernadette | 09 March 2016


Hi Peta , Good to read this but oh so sad.
Gavin | 09 March 2016


It made me cry! I know her. She is me! Since last August I have been caught by the black dog, it pursued me and ran me down! It was over powering, knocked me senseless! I couldn't cry I couldn't laugh I couldn't eat or love or sleep I HIDE I hide from you my loved ones; my best friend; my best buddies! When will it leave? When will the black dog move away and leave to set on another hapless soul! O Peter you say it always everyday everywhere you travel "LOVE LOVE LOVE" It's all we need!
Helen Furlan | 10 March 2016


The idea of TV consultations is horrific but a health system that is governed by the bottom line is bound to have major problems. You are kind in your comments about the mental health teams but unfortunately too many of them are run by people who have become cynical due to the excessive demands that have been placed on them. Hopefully your article together with others like it will help to lead greater realization that ordinary, normal people experience depression and that for some the depth of depression is overwhelming but that always they are just your average person dealing with their issues and needing the love and understanding that we all need.
Barb | 10 March 2016


Peter I love your insight, sensitivity, and empathy. I believe the world is a better place for you in it! I have been under the care of the mental health system and the people are warm, compassionate, caring & qualified. They were there for me, they did all they could and more ...I was able to see a psychiatrist even tho I waited weeks. I could have been admitted but was scared of the effect that might have on my family & friends! Which is ridiculous, because all they wanted was to see me return to health! But it was my phobia and fears, my anxiety, my depression that made me think like that! My hope is that these units are fully funded in the future and can get resources from government bodies. I would look longingly at the sleeping tablets prescribed and think if I could just take them all I might be able to get to sleep stay asleep and wake up feeling better! Unfortunately there are no Quick Fixes there are no pills for depression ... Time and love love love will turn that dog into a puppy with a warm wet tongue!
Helen F | 11 March 2016


Thanks Peter for this incisive article. I have worked in the welfare service sector for years and can honestly say the system designed to assist people is broken. With the advent of technology we are required to refer people via email, and try to load more tech work into our day. So many times the technology doesn't work or is too laden with jargon and people fall through the gaps. While we strive to be a science and knowledge nation we are leaving people behind at the rate of knots. It's ridiculous to think that we pour money into new on line services and rip money out of face to face services. Social isolation is growing daily and online services are just not the answer.
Kate Hamilton | 16 March 2016


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