Tag Archives: bipolar

How you do it: navigating mental health services in NSW


*In this post, I am talking about experiencing mental illness/craziness/non-neurotypicality as someone who works within the medical model. I am not discarding the importance of the experiences of those who choose a different path. I am also using the word ‘crazy’ to self describe as it is shorter to type and is how I identify.

This is a rough guide to accessing crazy-services in NSW.

I’ve been diagnosed as crazy since I was 19 – almost ten years – so I’m at a point where I’d describe myself as an ‘old hand’ at navigating the NSW mental health care system.

I’ve never been admitted, so I can only speak about how to navigate services pre-admission.

WHO IS THIS FOR?

To the pre-diagnosis, or ‘pre-treatment’ crazy person, it can be overwhelming to try to understand how to go about getting help. It can be tiring when you’re already so tired, so ill, so worn down. Maybe you avoid seeking help because it all just feels too daunting. This is for you.

Quite possibly you don’t and won’t identify as someone with an ongoing health issue – you’re just having a rough time in your life and need some support while you get through it. This is for you too.

I am sorry you feel horrible. I hope this helps you feel better soon.

THE MOST IMPORTANT THING

Do NOT listen to friends or relatives or the media who tell you that the ‘system is fucked’ and there’s ‘no help out there’. This is actually bullshit.

The system is deeply flawed, but there are lots of (often free) services waiting for you. They are not perfect but the most important thing to remember is that they ARE there.

If you’re feeling unwell, it can be super easy to focus on all the pitfalls of any action you take. If you can, avoid thinking about how services will fail you before you’ve even started.

THE EARLY STEPS TO GETTING HELP 

If you are in crisis or immediate danger

If you are in crisis: (suicidal, extremely unwell to the point of being debilitated/dangerous to yourself or others or just not coping) contact your local Crisis Team. Each area in NSW has a Community Mental Health service, with an attached Crisis Team.

They will triage you (ask you questions to find out what treatment you need) over the phone, come to your house to check on you, send an ambulance to get you if necessary and also provide follow up care. There are links and numbers at the end of this post.

If in extreme danger to yourself or others call an ambulance – DIAL 000

If you are unwell but not in immediate danger  – welcome to your GP appointment!

If you are unwell but not in immediate crisis: make an appointment with a General Practitioner (GP) to get the ball rolling. Follow these steps.

Book a ‘long appointment’ with your doctor. The first time you make contact with your doctor will take a long time due to paperwork and their taking a ‘history’ of your condition.

If you feel extremely unwell/unable to articulate your needs and condition, take an advocate. This is a friend or family member who can chat to your doctor on your behalf, and provide moral support.

Tell your doctor ‘I am feeling unwell and I need to get help and make a mental health plan’. Make sure you fully describe your symptoms. Try not to leave things out because you are embarrassed. At this time, if you have wounds from self injury that need attention/stitches etc, ask your GP. They are more likely to be gentle with you than ER nurses/doctors.

What’s a mental health plan? This document includes a general description of your situation, and a path forward for treatment. THIS IS A VERY IMPORTANT DOCUMENT. You need the mental health plan to access monetary rebates from psychiatrists, psychologists etc and to keep track of your medication and how you are going.

Psychologists and psychiatrists and meds, oh my!

If you are very unwell and need to see a psychiatrist, your GP should find you one in the public system so it will be either free or less costly. If you need a psychiatrist appointment and your GP doesn’t offer to connect you with one, ask for this.

Psychiatrists are there to fiddle with medication and keep a very general track of your progress. Psychologists are there to help you discuss problems, issues and feelings and work on strategies to overcome them.

Your doctor will look up a psychologist for you in their database. This person will be recorded on your mental health plan. You can ask for one that is queer friendly, or a woman, or a person of colour and so on. This is your right. Ask for a psychologist who is within easy travel distance from you, if you are low on energy.

You pay for each psychologist session up front and get a substantial Medicare rebate back. You need to take your psychologist’s paper invoice into a physical Medicare office to get your rebate. There are a few psychologists who bulk bill, but they are quite rare.

Each appointment with a psychologist runs for about an hour. Try not to be late, because you will still be charged for the time, and psychologists are often quite busy. Ask your psychologist how much notice you need to give to cancel an appointment. Some will still charge you if you don’t give enough notice.

Your mental health care plan allows you six initial sessions with a rebate. Then, your psychologist has to send a letter to your GP reviewing your situation and saying if you need more sessions. At the moment you get another four, then another six after that. The number fluctuates based on changes made to Medicare at a state government level.

Your doctor will give you the psychologist’s number. If you feel unable to call to make an appointment, tell your doctor and they will do that for you. You can also ask your advocate to help you.

Your doctor will want to discuss medication options if appropriate. They may prescribe something for you. The ‘medical model’ is psychotherapy + medication = best general treatment approach. You do not have to take medication prescribed for you, but it may be in your best interests to do so, even if only short term.

Most psychiatric medications take about six weeks on average to ‘kick in’. Don’t expect to feel better after the first pill. It needs time to build up in your body and work.

You have the right to ask your doctor about side effects. Make sure you ask how to use it properly – how often to take it, if you can drink alcohol, if you need to drink extra water and so on.

Make sure you tell your doctor about any other medication you’re taking to avoid clashes with new medication, and to taper off any existing medication if you need to before starting this new one.

Once your mental plan is completed, you should receive a paper copy and your doctor keeps one on file. The mental health plan is usually reviewed once your Medicare allowed psychologist sessions expire.

Make sure you book in to see your GP about six weeks after starting new medication to check on how it is going and if is starting to work for you. You can discuss any problems you are having with it or request a medication change.

Now you should have:

  • access to a psychologist that should hopefully only cost you $40 an appointment or so after a rebate
  • access to a psychiatric appointment should you need it
  • access to some start up medication should you need it
  • access to crisis services should need them
  • a clue-by-four and less confusion!

IMPORTANT NUMBERS AND LINKS:

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Bipolar depression is…this.


Depression is making a gratitude list in your head, and realising all you have on it is things like ‘breathing’ and ‘this coke I am drinking’.

Depression is realising other people have much better gratitude lists full of charming, engaging, fun and nourishing things, and hating them for it.

Depression is then realising you didn’t include friends, family or your cats on your gratitude list and feeling like even more of a shithouse human being.

Depression is realising complete, sustained unconsciousness is better than this. Some call that death, or just sleeping for a long time without the obligation to go to work, or being knocked out by booze or other drugs.

Depression is saying aloud to a friend that yeah, you know you can’t realistically kill yourself, because you’d need at least 10k in the bank to sustain your cats after you die, and you have less than 2k.

Depression is resenting your cats for being dependent on you and thus meaning you can’t leave them.

Depression is hating other people for their happiness. Depression is wishing there was an unlike button for all the ‘happy couple’ photos on facebook.

Depression is believing you will never again – and probably never really did! – enjoy a meaningful relationship with another human being.

Depression is not even caring that you’re stuck in a shit job where you are treated badly most of the time, because you deserve it.

Depression is constantly updating your status so you can feel like your barely meaningful notable existence has somehow been etched into significance.

Depression is looking at broken glass at work and grinding it into the ground, wishing your feet were bare.

Depression is eating horrible, empty-caloried, nutritionally blank food that doesn’t even taste good because your love for food has vanished.

Depression is blowing off social engagements to hide in your bat-cave.

Depression is a pain, just inside your chest, when you laugh without any real mirth, and to replicate a socially expected response.

Depression is engaging in mental self-harm by listening to songs from your wedding, specifically because you know it will hurt like hell and trigger you and you want to do that.

Depression is searching your house over and over for an old valium stash and not finding any and laying on your bed and staring at the ceiling for hours instead.

Depression is boring exhaustion and heavy, stuck shut mouth that can’t be bothered.

Depression is over identifying with songs, movies and art and feeling physical sensations of anxiety, discomfort, and wrecking sadness after repeated ingestions of hurtful media.

Depression is starting by not caring that you feel like shit, to actively wanting to feel like shit. Because that seems fitting, and deserved.

For me, that’s what depression is, for a few weeks every now and again. It never lasts, and always returns – there’s the rub.

And that’s how I feel at the moment.

That’s why I’m blowing you off and dodging your calls and answering your “how are you?” with “yeah…you know.”

Fill in the blanks with something positive. I’ll happily live in your imagination until I return to life.


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