Mental Illness

Psychiatric Problems
In trying to understand issues around bipolar disorder it has become apparent that I do not have a solid framework to understand and manage psychiatric problems.
There are many reasons why it is difficult but I will not go into them at this stage.  Treatment options have expanded and there many more medications targeted at specific problems.  I have never been convinced about CBT.  It seems like trying to convince one person by talking to them that they must behave differently.  So this has forced me to distil and put down my ideas.
What has happened is that a person’s behaviour is not appropriate in society and is harmful to themselves. The practice of aberrant behaviour being managed by simply talking worries me.
What has happened?    The patient has made a series of choices to cope with external stresses and their internal responses.  These choices of action are unique to the individual, while many can be grouped as a global response common to many people. But now as society crumbles, as the belief structures of the individual crumble then they no longer are dependant on older belief structures.  Such people have to turn inwards to themselves in order to cope.  Using outside agencies / non-Christian belief groups all disappoint in the end.  So the person has to rely on their own self constructed belief system to cope with life.  So the person tries to cope within this framework and for many the adjustments in response based on this framework hold up.  So people get through the day.
It is when the constructed framework is not able to help, especially when the person has severe destabilising external or self generated stresses trying to cope.  So the framework collapses and in order to preserve themselves they must behave in ways that are not in keeping with the normal behaviour of society.
This is the genesis of mental illness and the form it takes is determined by the person and the constant behavioural responses to various stresses they have made since birth.  All in order to preserve themselves as a person.
Prevention
If from an early age  or even later) people can have a different approach to life.  To cope with the threats / demands made on them. To have an understanding that they are part of the glory of God.  That the Holy Spirit can energize them and they can deal with external threats / pressures in a way that sees God is in control.  No matter what is the problem God always relates with us – in and through the Holy Spirit.  So now they can make better choices of behaviour out of an understanding of God and His world. It is not just about “me trying to cope on my own”.  It is about “me coping using the resources of God and my part in the Kingdom and in worship.”
However sometimes we see people go away from that and revert to their own self belief and actions, with consequent distortions of behaviour often seen.
Some have become too entrenched in their behaviour patterns and change is next to impossible.  In these cases risk / harm management is all that can be done because the torment to the person is very great. Some others go through life crippled but functional – cure is not the word to be used.
So in helping these people.
We should focus on who they are as individuals.  Where are they heading in life?  What is stopping them. We should say that that it is possible to change how you relate to the world and to people.  If you want to change this aberrant behaviour then it is possible by seeing yourself as a caring person concerned with the world outside of themselves.  To see yourself as part of God’s glory of creation, energised by the Holy Spirit. If they chose not to do so, then it is because the behavioural pathways of coping are so entrenched and all we can do is harm / risk minimisation.
Basis of my management
It is out of this framework I approach my patients and manage their mal-adaptive mental mechanisms.  I try to encourage them as individuals.  Sometimes the reversal of such mental mal-adaptions needs the miraculous intervention of the Holy Spirit of God. This in fact is the basis of all conversions.
I realise that I can only half treat the patients who have mental disturbances if I do not attempt to treat them within the dimension of the Christian faith which directly addresses issues of dealing with a guilty conscience.  All through any management approach I must see the person as a child of God, responsible to God and acting in a responsible manner.  This may not be what actually happens but it is the treatment goal to which I should aspire.
 

 

Super Clinics and workforce issues

GP Super Clinics and other GP workforce issues
Just some ideas and thoughts about these issues
14 of the 32 Clinics are going to be in places where GP’s are in reasonable supply.  They have to be established there so as to attract doctors to work in these “super” clinics.  That is where the doctors will come from  These clinics will compete with local GP’s and such GP’s will be forced to join to survive.  That will be a good start to get a group of caring GP’s.
The policy framework of these Clinics will have to lay down After Hours / Home / Nursing Home visits or else there will be a lot of flak.  Probably be in the “tender” documents.  What will happen is that they will charge a lot for such visits or giving it to Locum Services.  There will essentially be no difference to a Corporate set up because the govt will not want to continually prop up such clinics.
Training of GP’s will be part of the set up  and more training $ will be paid to get this going and so lessen the need for smaller clinics to employ such registrars.  These training places will be like the hospitals when they train surgeons / physicians.  Govt money will flow to make sure such training will happen.  If  the clinics appear to be failing then money will flow in to support them.
So the metro market will settle down with these centres focussed on training.
The fact that they will be expected to bulk bill also means that people will tend to go to these clinics.  Also this fits with a report that this is the style of practice the under 25’s want. This episodic approach by patients plus the increasing supply of doctors will downgrade GP work.  Eventually there will be too many metro GP’s.  They will not be driven into the country because 70+% will be female.  Anyway why do rural work with the added rural layer of problems such as Hospital work and emergency work without a lot more money to compensate?.  Why relocate?  Instead niche practices will spring up such as skin , asthma and diabetes.
Even if a 2 year contract offered to relocate to a rural area because then you have to return to what…?   So instead get into a metro practice keep your head down and work 9-5. This might be alright for a female but not a male doctor.  So what will happen.  He will just settle in and do his job and make $.  He will not complain unless there is more money to make. He will develop a life outside medicine such as real estate development or shares.  He will just do the bare minimum in the Practice and chronic disease management will suffer.  He will become self and not practice orientated.  Medicine will just be a job to make money.  He will be very compliant and do whatever the govt wants.  But if it gets very hard he will leave medicine.
This behaviour will be reinforced by the big clinic’s approach to these doctors.
It does not that there will be much interest in chronic disease management unless the clinic organises it.  It is a bleak picture but a realistic one by a group of disaffected professionals unable to move outside defined practice guidelines dictated by governments.
Trebor