And I am aching to get there, straining towards the moment I close the door to my hospital room on a world I am the wrong shape for right now.
How did I get here this time?
Fourteen days ago I had a regular appointment with my psychiatrist. Just a Bipolar 1 Disorder monthly maintenance appointment. I was completely asymptomatic.
Thirteen days ago I left for our beach holiday and forgot to pack my swim wear. Subtle. I mean that could happen to anyone. Right? But by the following morning I was symptomatic alright. My short term memory and concentration were dissolving like sugar cubes in boiling water.
A buzzing pressure behind my eyes radiated up my forehead. I knew from bitter experience, if I did nothing, soon that buzzing could make me second guess what was real or not.
That was symptomatic enough to page my psychiatrist on a Saturday morning. It’s only the second time I’ve paged him out of hours in 14 years. He called back in under three minutes.
Over the last nearly two weeks, the first of which I stayed at the beach, he telephone consulted with me every second day, adjusting medications, a little more of this, a little more often of that. I slipped from my bed gratefully into the ocean, timing the most sedating medications for times when I’d be in bed not the ocean. I seemed a little better, maybe? But then not.
Back home we continued every second day phone consults, adjustments. This is by far not the sickest I have ever been (although psychosis and catatonic depression requiring ECT to reverse, do set a very low bar)
So why would I want to go into hospital, rather than continue treatment at home?
The surface of my brain feels as though it is covered in papercuts and being surrounded by people and noise is like having lemon juice dribbled over the cuts.
Trying to hold in the irritability of being around people and noise (including my close family) is like being intensely nauseous with someone threatening to punish you if you vomit.
One of the parameters I use to assess how close I am to needing to go into hospital is ‘the sandwich test’. Think about the amount of concentration and short term memory it takes to make a sandwich – nothing fancy, just two slices of bread, some butter and one topping. For most healthy, able bodied, able brained adults, this is not a challenging task.
Right now – I can still make a sandwich, but it’s a challenge. I am making a decision, based on past experiences, not to wait with hospitalisation until challenge becomes an impossibility.
As for the seasonal timing – Christmas and New Years celebrations? I am veteran enough in the management of this illness to know it has no knowledge of nor respect for holidays and anniversaries. I could list my tenth and fifteenth wedding anniversaries as times spent in hospital, a longed for trip to Paris cancelled because of recent hospitalisation, and that would be the beginning of a list so long I’ve forgotten most of it. These times are just human constructs. If it swallows them I don’t dwell on them.
Instead I celebrate the unscathed special occasions extra hard, to make up for the times there is nothing.
The final reason for going into hospital now, is because I can access this level of care. I am fortunate to have the option of going into a private psychiatric hospital when I am sick. The standard of hospital care I will receive will be excellent. It will far exceed anything the public psychiatric hospital system has to offer.
I loathe getting sick enough to need hospital support. But perhaps even more than this I loathe the hypocrisy of someone with my privilege not utilising that support because of some misguided stigmatising ideas about what it means to be a patient in a psychiatric hospital.
I am profoundly grateful I can afford care in a good private psychiatric hospital. And part of my own recovery, once I’ve stabilised medically, is to remember there are many people living with this illness, and other severe mental illnesses, who are learning to live with them with far less support and privilege than I have. When my recovery feels hard I focus on this:
If I access the supports I am fortunate to have, I am more likely to be around for long enough to help raise awareness of the inequality between our private and public mental health hospital systems, and work towards our public mental health hospital system actually supporting some of our most vulnerable when they need it most.
If you are new to Thought Food and would like to know a little bit about who I am when I am well, you may like to check out:
The second one was released recently and dives deeply into my work life before and after the onset of Bipolar 1 Disorder, and the adjustments I had to make for it to be sustainable. It hopefully goes some way towards dissolving the myth that it is impossible to function highly when living with a severe mental illness.
I was interviewed by Dr Kimberley Khodakah and you can find that episode here:
It will be well intentioned. It may come from a place of not wanting to replicate your own upbringing or the mistakes you think other parents are making. And it will probably be informed by your experiences and biases.
I’ve always known this…in theory.
But the other day my fourteen-year-old daughter courteously yet clearly served my imperfections in this area up to me. This was no teenage tantrum. It wasn’t even an argument. It was simply a conversation in which I was presented with unpalatable information about myself, and then had to choose what I did with it.
It started simply:
‘Mum, can I please get TikTok? Remember I asked you about it a month ago, and you said you’d think about it.?’
For context – she gained Snapchat and Instagram over the last few months, to my knowledge has not abused any of her privileges, and right now appears to be in good mental health.
So, we talk about how she’d manage seeing distressing content if it popped up. I probe her with her worst-case scenario.
‘What about animal cruelty?’ I say and follow it with a graphic example.
‘I’d talk to someone about it.’ She answers calmly.
‘Who would you talk to?’
She doesn’t hesitate: ‘Well definitely not you! Probably Dad.’
‘Why not me?’ I ask,
‘You and your mental health stuff – you’d blow it all out of proportion, take me to a psychiatrist, have me medicated and force me into years of therapy.’
I did ask.
And while she is wrong about the imagined consequences of telling me she saw some distressing social media content, she is right about something else.
I am hypersensitised, filled with knowledge of the very worst mental illness has to offer. And not just my own. Every time I go into hospital, I share that space with others who are going through their own worsts.
When I see young inpatients often only four or five years older than my eldest child with bandaged wrists or cutting scars, bolts of fear shoot through me. Fear that one day my children could hurt like that.
Every time after my Bipolar 1 Disorder has put me through hell I am frozen by the threat that I will have given this illness to my children. I know that (beyond not introducing significant trauma to their lives and warning them of the dangers of drugs that can trigger the genetic component of this illness) there is nothing I can do to outparent it. But I still try.
After I got sick I was determined my children would grow up in a family that was open about mental illness. There would be no shame and no stigma. They would know from a young age where I was going when I went into hospital and why.
The knowledge that sometimes mental illness sprouts in childhood and adolescence is heavy and made heavier by the fact that sometimes it is fertilised (even in the absence of major trauma) by parents unwittingly invalidating their children’s’ feelings or experiences.
I never wanted to be that parent. And I am not. But I may have made the opposite mistake.
By unintentionally force feeding my children my concerns around mental health, could it cause them to turn away from the very tools that could help them should they run into a mental health crisis?
Mental health is stitched into the fabric of our family’s conversations partly due to my lived experience, but also because of what I do. My children have never known a time when I haven’t been a vocal mental health advocate. I write about it. I talk about it frequently – sometimes quite publicly.
And if I dig deep into my motivation for wanting to change the way mental illness is perceived and treated, my children are at the core of it. That motivation is as simple as it is unrealistic:
I want to fix our mental health system so that it can help rather than harm my children should they ever experience mental illness.
I am loathe to admit it but yes sometimes all my motivation, knowledge and focus, can morph into hypervigilance, ready to pounce on the very whisper of something not being right with my children’s thought patterns. And in my futile efforts to protect them from my worst nightmares, at times I probably veer dangerously close to pathologizing their emotions, which can be as damaging as not acknowledging them at all.
I do this reflexively even as I know that parenting out of the fear of what could happen is even worse than living your own life ruled by fear.
And yet, deep down I know that if either of my children get sick it won’t be my fault or TikTok’s. If that happens, hopefully their father’s less informed love will be the perfect counterweight to remind me that while my knowledge might be useful in some situations, at other times applying the full weight of it can be like attempting to kill a fly with a sledgehammer. Ineffective and potentially damaging.
It was a yes to TikTok.
While I am deeply grateful that right now neither of my children require psychiatric care, my advocacy work will continue, because it is grim out there. I caught up with a friend recently whose child does need a child psychiatrist urgently. The waiting time to get an appointment with a private child psychiatrist is currently twelve months.
Or there’s the public hospital Emergency Room if symptoms become life threatening while you wait…
Published with full permission from the fourteen year old who also helpfully pointed out I’d misspelt TikTok in the previous draft.
I ask because uncertainty is having a moment right now. It galloped in with the Covid-19 pandemic, and the further we get into it the more it seems to be digging itself into our awareness.
I used to be deeply uncomfortable with the pebble of uncertainty in the shoe of my life. I liked to know what was ahead. It gave me a (false) sense of control and the misguided belief that just because I couldn’t see uncertainty in my life, it didn’t exist. I deluded myself for decades that when there were no clouds on the horizon, the course of my life was somehow more certain than if I could see trouble ahead.
Then all the certainty in my life was put through a paper shredder within five days of my first baby’s birth.
I got my new baby experience with a side of florid postnatal psychosis severe enough to warrant admission to the locked Special Care Unit of a psychiatric hospital. My sense of certainty and control over my life went down the toilet.
After I’d recovered from this psychotic episode I felt entitled to some certainty. I wanted to know this nightmare was over. And I wanted a guarantee it would never happen again.
So when my psychiatrist mentioned ‘a possible underlying Bipolar Disorder’ and that it would ‘take three to five years to know for sure’, the inside of my head threw a combination of a tantrum and a pity party.
When I got sick again after three years, after seven years, and after nine years and my diagnosis of Bipolar 1 Disorder was confirmed, I still felt entitled. Entitled because: ‘hadn’t I suffered enough yet?’ Entitled to not have to tiptoe through my life with everything clenched, waiting for the next time this thing pounced.
I have only recently acquired some degree of acceptance of the uncertainty this illness introduced into my life. I didn’t enjoy the last two episodes in 2018 and early 2020, but I also didn’t waste energy resisting them. In the same way I no longer spend any of my resources anxiously wondering when it will happen next and how bad it will be, because without wanting to sound nauseatingly Zen, the truth is: It will be what it will be when it will be.
Uncertainty exists in everyone’s life every day. But instead of it floating along in the background, right now it is constantly being rammed down our throats. It’s like having a nasty little gremlin on your shoulder whispering over and over again:
‘You do realise bad things could happen to you at any minute’, when the true risk of something bad happening to you is probably not that different to pre-Covid times.
For our mental health to survive this pandemic we have to learn to live with uncertainty, because the end of it is nowhere in sight. And just like my psychiatrist couldn’t give me any certainty when I first got sick, the smartest scientists in the world aren’t able to accurately answer this question about Covid-19: Will it ever be over, and if so when?
Uncertainty is an uninvited, kicking, snoring bedfellow. So how do we get comfortable with it?
First we tease out what about this situation we can control and what we can’t. For example, we can’t control the flow of information that feeds our uncertainties rushing over us every day, but we can control how much of it we absorb.
And once we’ve done what is in our control to help ourselves, we have to try and unclench from the need to know what is going to happen next. We need to stop trying to know and plan for a future that is like a spiderweb in a storm. Here’s what I mean:
During one of my admissions to hospital I sat staring out of the window of my room feeling as though there was no point in doing the work to rebuild myself because my future was too uncertain, my illness could tear me apart again anytime.
Over a couple of days of intermittent staring I noticed a spider in its web just outside my window. Every night it stormed. Rain, wind, a couple of times hail tore chunks out of the web, at times almost destroying it.
That spider showed me the way out of my tangled thoughts, by not only rebuilding every time after its pristine web was wrecked, but doing so in the face of the risk of the same thing happening again, whether the next day or in a year.
The sword of an uncertain future has hung over every single one of us since the day we were born. Nothing has changed there. It is just up to us whether we choose to battle with uncertainty and lose, or whether we accept that being alive will always mean living with uncertainty, pandemic or no pandemic.
Saturday 10th October is World Mental Health Day and I feel a little conflicted about highlighting it. There are a lot of positives to having dedicated days or weeks to draw our attention to mental health. But I also believe we need to approach these awareness days with a little caution. It’s too easy to post or repost something related to the topic, tick the box of doing good and move on with our days.
Ironically these tokenistic efforts are becoming more common as awareness around mental ill health grows, especially when we don’t have to move beyond the comfort of our keyboards to feel as though we are achieving change. Of course it is good that there is more awareness, tolerance and marginally less stigma surrounding mental ill health than there was fifty or even twenty years ago. But we have to make sure we don’t replace the old insensitivities with their more modern counterparts.
I have written about my dislike of RUOK day before RUOK Day: Full Disclosure and this year I heard another perspective that reenforced my reasons for disliking this day. When I am well, my psychiatrist appointments usually consist of me requesting scripts for any medications I am running low on, a brief check in with how I’m going and then we chat about the state of the world, my advocacy work, his psychiatry work. This year one of my appointments happened to fall around RUOK day and we talked about the pros and cons of this day. I expressed my opinion and my psychiatrist referenced one of his patients coming in on RUOK day in distress because they were bombarded by people they knew asking them if they were ok. People they didn’t hear from for the rest of the year. People who were probably well intentioned, but using them as the token mentally ill person in their lives, to tick the box of having asked: RUOK?
Awareness around mental ill health should not be confined to one day or one week of the year. Episodes of mental illness flare unpredictably and feel as though they will never end. This feeling is fed by the fact that no one can tell you when it will end. There are good days and worse days. There are days when the risk of it turning into a terminal illness skyrockets. Someone may have a spectacularly good day on RUOK day, a calm and uneventful mental health week, but be suicidal sometime in April or on Christmas day, when it is all too easy to be under the impression that we showed our support for those among us living with mental illness back in mental health week, and Christmas day is busy and by April we are into Caesarean awareness month and IBS awareness month.
So what can we do to be meaningfully aware of the impact mental ill health has on those of us who live with it, and what can we do to support them for more than a day or a week of the year?
Everyone who lives with mental illness is different and everyone’s experience is different even if they live with the same diagnosis. So, I don’t speak for everyone.
For me – I don’t need to be asked how I am. I have enough insight into my Bipolar 1 Disorder to know when I need to seek help. I am fortunate to have good support systems in place, so I don’t tend to feel lonely or isolated.
For me it is all about the language people use. Hearing or seeing stigmatising language either in the media, on social media, or spoken, punches me in the gut. When I am confronted with words like nuts, crazy, lunatic, psycho, mental institution, – the list is long – it belittles me. It strips away the facts of my life, my healthy functional relationships, my personality, my university degrees, my profession, my interests, my sense of humour and it reduces me to a hellish caricature of who the misinformed masses believe someone mentally ill is.
So, think about how you write and speak around me. If you hear or see someone else perpetuating stigmatising language around mental illness, call it out. Do so politely, but raise awareness of it. I do it as often as I can, but I also get tired of being told to shut up, get over it, or that I am overreacting.
Perhaps the most helpful thing you can do for someone in your life who lives with mental ill health is not to automatically ask them how they are, but to ask them what you can do to make them feel valued and supported all year round. They may answer: ‘Ask me how I am’ in which case you are doing it meaningfully and mindfully, not because it is a certain day of the year.
All that said, Happy World Mental Health Day everyone. In honour of it also being Queensland Mental Health Week from 10th-18th Oct I am aiming to drop a few additional posts in Thought Food this week.
If I were to call out language that stigmatises mental illness every time I came across it on social media, I’d be posting about it every couple of days. But no matter how called for I may feel it is, I don’t want to douse my readers in a bitter diatribe that often. I also enjoy a break from being told to shut up or get over it by people who don’t agree with my assessment of stigmatising language. So I’ve let it go for a while.
But I came across the following facebook post recently, which hit a nerve and left it throbbing for long enough to drive me to the keyboard:
Now, I don’t like the word lunatic – but that is the least of the problems with this post. And as much as I’d like to agree with the sentiment, I have to ask:
What does this post imply about those of us who live with severe mental illness?
It equates us with people who believe and propagate fake news. The most pejorative label for people who don’t believe in climate change, the author of that snippet could come up with was to portray them as mentally ill.
Anti vaxxers, people who don’t believe in Covid 19, or who don’t believe in climate change don’t have those beliefs because they are mentally ill. They believe them because they are poorly informed and possibly brainwashed.
So, let’s not conflate pathological delusions experienced as a symptom of mental illness with people who are just misinformed and who refuse to delve into some scientific research.
I live with Bipolar 1 Disorder, and have experienced delusional thinking as a symptom of this illness. I not only believe in climate change, I am very concerned about it. I believe the overwhelming benefits of vaccination outweigh the few risks. Covid 19? Of course it exists. Donald Trump? Ten of my posts wouldn’t be long enough to list the reasons he has to go.
And yet when I jump onto social media I am bombarded with posts that tell me that the best way to insult the people who believe the opposite of the truth is to call them mentally ill, and thereby imply that if you live with mental illness you are in the same category as people who can be brainwashed.
Delusions caused by mental illness are completely different to the overconsumption of, and belief in, fake news. By labelling all of the people who don’t believe in scientific proof as mentally ill you insult and dismiss the many people who live with mental illness and who are critical thinkers who do believe in scientific evidence.
I can only speak from my experience of delusional thinking, but here’s what I know:
Delusional thinking isn’t a contagious false belief system you are indoctrinated with. True delusional thinking as a symptom of mental illness is completely involuntary. You don’t choose to experience it. It sweeps in on the coat tails of an illness that fundamentally changes how you interpret the truth.
For me, delusions are accompanied by mania which at its worst tilts into psychosis. The inside of my head feels as though I am riding a rollercoaster that’s on fire. I don’t sleep. The first time it happened, I tried to convince everyone of the truth to my malignant belief system. And in my experience true delusions due to mental illness resolve with antipsychotic medications.
The chances are your average antivaxxer or climate change conspiracy theorist will not change their beliefs if you dose them with antipsychotic medications.
So, If you read the post above and shrugged your shoulders or like several of my facebook friends gave it a like, let me rewrite it for you and see if you change your mind. Here goes:
‘If you believe all of (sic) world’s scientists got together to fake 7000 climate studies as part of (sic) elaborate hoax, you are not conservative you are a cancer patient. We have to stop treating people brainwashed by right-wing propaganda as political actors and start treating them on an oncology ward.’
Uncomfortable yet? You should be because the implication that people who live with cancer are idiots, is as ridiculous as it is insulting.
So why is it ok to equate my serious mental illness and the fact that I have at times spent months in a psychiatric hospital to me being an ignorant conspiracy theorist?
Kanye West is unwell again. Hurtling through a manic Bipolar episode while the world laughs. And as someone who lives with Bipolar 1 Disorder, I feel for him.
In the early years after my diagnosis, during one manic episode (while hospitalised) I started discussing my sex life with strangers. My friend who was visiting me steered me gently away.
Kanye doesn’t seem to have anyone to steer him away, gently or otherwise.
Kanye is a wealthy, influential man, who probably has access to the best mental health care available. But I don’t believe his problem is accessing top quality care.
His problem is that he lacks insight and no one around him is game to have the difficult conversations with him. The conversations that point out that while he may be a brilliant artist when he is relatively stable, when he develops manic symptoms his brain needs a break from the world, and the world is not entitled to its contents.
Instead, when Kanye becomes unwell his mania is left to run free.
He has been open about his choice not to take medication to help manage his Bipolar Disorder. That is his right. Medication doesn’t work for or agree with everyone.
But he seems to be unaware that to successfully manage this illness without medication, you need to employ other strategies. You need to hone your insight. And if your insight when you are unwell is shaky, you need a mental health directive.
This means sitting down with your doctors and people closest to you when you are well and discussing how you would like to manage your symptoms when you are unwell. And if you experience manic episodes, one of the most basic requests may be to not have access to the media – social or otherwise – while symptomatic. Why?
Because mania can gobble up your inhibitions, make you see the world through a paranoid lens, and sprout delusions of grandeur.
Kanye recently gave an interview to Forbes magazine during which he rambled for four hours, to this effect:
‘…They want to put chips inside of us, they want to do all kinds of things, to make it where we can’t cross the gates of heaven. I’m sorry when I say they, the humans that have the Devil inside them. And the sad thing is that, the saddest thing is that we all won’t make it to heaven, that there’ll be some of us that do not make it.”
“Clean up the chemicals. In our deodorant, in our toothpaste, there are chemicals that affect our ability to be of service to God.”
If Kanye were a homeless man on a street corner sharing these ideas with the world, the interviewer from Forbes magazine would probably have walked past quickly, maybe shuddering at such overt insanity.
Instead that interviewer sat and listened to him for four hours. Noted down delusional quote after quote and then published an article in which they even describe Kanye’s lack of awareness:
‘If it all sounds like a parody, or a particularly surreal episode of Keeping Up With The Kardashians, West doesn’t seem to be in on it.’
Of course West isn’t in on it! He is walled off from reality by illness.
Did that interviewer ever pause to consider why much of what Kanye was saying made no sense? I suspect (with disgust) that they were fully aware their high profile subject was mentally unwell, but chose to exploit him while he was most vulnerable.
I have written thousands of words I thought were brilliant, while in the grip of mania. But once my symptoms recede, I am relieved no one else has read these largely nonsensical word vomits. Because if they had, that would invalidate the quality of my writing when I am healthy.
But Kanye’s word vomits are out there for all the world to snidely pick at, to brand him a rambling idiot and someone to be sniggered at.
At the time of publishing this post, headlines announcing Kanye’s withdrawal from the presidential race are emerging.
I understand stress and sleep deprivation are a president’s companions for most of their time in office, that pushing through is a corner stone of juggling the demands of the job.
Stress and sleep deprivation are the perfect fertiliser for Bipolar episodes to flourish. Bipolar episodes, once active, can’t simply be pushed through. They have no respect for deadlines or work demands – let alone international or national emergencies.
Whether Kanye recognised the risks of pursuing the presidency himself or whether someone in his circle came forward to have the hard conversations and steered him gently away, I am relieved for him.
I never considered my mental health as part of the decision to have a baby, because when I first fell pregnant within a month of trying, I had never experienced mental illness.
The pregnancy was uneventful.
Then I went into a thirty-three hour labour on two hours sleep. This severe sleep deprivation and the swirling hormone levels woke a slumbering monster, a genetic predisposition, which ensured that by the time my baby was one week old, psychosis had wrenched me away from reality. I found myself in the Special Care Unit of a private psychiatric hospital trying to explain my way out of my delusions, while my husband and mother cared for my daughter at home.
Long before Covid-19 arrived, vets and vet nurses were quiet, hard workers who didn’t complain about less than ideal working conditions. And, possibly unbeknownst to most of the pet owning public, for many veterinary staff, challenging working conditions were the norm.
Since this crisis hit, these essential workers are not getting much opportunity or airtime to communicate the difficulties they currently face at work.
The advent of the Covid-19 pandemic has put the challenges of veterinary work on steroids.
I know a bit about what it takes to work in this industry.
I fell in love with veterinary work at fifteen, when I started volunteering at a local vet clinic. I wiped down tables, cleaned cages, and held animals. Then I started work as a casual junior vet nurse on Saturday mornings.
I committed the second half of my teenage years to the tunnel visioned hard work it took to get into veterinary science at university.
I worked as a small animal vet for twenty years, in many different practices in Australia and the UK. Working conditions ranged from excellent to atrocious.
Thanks to my experiences, I know this:
Vets don’t talk about their work stresses outside their own tightly knit vet circles. Some of us don’t even confide our struggles to our colleagues. We talk about our cases in detail for hours, but many of us still cringe at opening up about the state of our mental health.
Our clients get our kindness, our compassion our sympathy our skills our knowledge, our communication skills. But they never see our vulnerability. They don’t understand how high our risk of burn out (borne of caring too much and being overworked and undervalued) is.
They don’t see that when we walk through the door of the clinic our rostered working hours become irrelevant because we give ourselves over completely to everyone else who walks through that door after us.
Our clients don’t feel our pain when we lose yet another amazing member of our profession to its sky-high suicide rates.
I am currently taking a break from veterinary work while I concentrate on writing and mental health advocacy work. But I have many vet friends who are out there working and hurting.
I have spent the last couple of weeks collecting descriptions of work life from some of my (currently working) veterinary friends and contacts, because I believe that for the veterinary profession to survive this pandemic with its collective mental health relatively intact, the pet owning public needs to know about the difficulties its workers face at this time.
Here are some of the (summarised, paraphrased, and quoted) insights these vets generously shared with me:
On Covid-19 Regulations:
Some aspects of veterinary work make social distancing between staff impossible. For example, it is not feasible for a nurse giving a wriggly, excited puppy a cuddle and a vet looking in its ears with an otoscope, to be 1.5 metres apart.
Some of the protocols necessary to minimise the risk of Covid-19 transmission, such as contactless consultations (where the owner waits outside the clinic in their car, the pet is transported inside by a nurse in PPE, the vet examines the pet and then phones the owner to discuss further diagnostics or treatment), severely hamper efficiency and slow everything down.
Vets are used to working as efficiently as possible:
‘Normally I would type the history while the owner is in the consult and do an exam in between taking notes. Now I can only do one of these things at a time.’
Contactless consultations also limit a vet’s ability to read their client’s body language during the consultation, which can interfere with effective communication between vet and client.
Pets can be more anxious when separated from their owners. This may mean it takes longer to perform a physical exam, or it may be impossible to do as thoroughly as the vet would like.
Covid-19 level cleaning recommended between consults is more labour intensive and takes longer than usual.
Downsizing or closure of a practice due to further restrictions or a Covid-19 infection will have negative effects on the practice’s financial stability very quickly.
‘The nature of small to medium sized veterinary practices even in normal times is to run with incredible efficiency, but still on very low margins. They cannot sustain even mild to moderate downturns. They will not survive and jobs will be lost long before the drop of 30% revenue occurs required to be eligible for the Job Keeper Payment.’
Locum vets are particularly vulnerable to job loss now. As practices work to minimise the risk of a Covid-19 infection in their permanent staff, many locum vets are having their shifts cancelled, and are facing the financial difficulties and mental health challenges that come with job loss.
Vets are also more aware than ever of the financial constraints facing many of their clients.
‘It is super sad when you see a client who wants to do everything for their pet, but they have lost their job and can’t afford it. It breaks my heart. I am doing a surgery at a 25% discount tomorrow. The client didn’t ask for it, but I feel so sad for them.’
‘I feel even more conscious of the usual dilemma we have in vet practice of having to mix financial discussions with emotive ones as most people are understandably a lot more stretched financially right now. But veterinary practices are also under a lot more financial stress and if our invoices are not paid, there won’t be a vet for clients to take their animal to.’
And now more than ever vets are at risk of being on the receiving end of their clients’ financial frustrations.
‘I’ve already been abused in the car park once this week and I am preparing myself for a lot more of that to come as the stress is almost palpable in the air.’
On Mental Health
Vets often hold themselves to a very high standard. Under sub optimal working conditions that pressure will increase stress levels further.
‘Veterinary practice is already an emotionally draining vocation with highs and lows every day. Our staff feel responsible for their patients and care for our clients. And it goes against the grain to just drop our standards of care because of what’s going on. So, we are not going to start cutting corners.’
Many clinics have split their staff into two or more teams to reduce the chance of the whole clinic having to close if one staff member contracts Covid-19. This means vets and nurses may be working under short staffed conditions and even longer hours than usual:
‘The phones are ringing constantly. We hang up and pick up the next one. I am answering dozens of phone calls daily as a vet, as well as being my own anaesthetist, recovery nurse, and doing the usual vet things. And right now none of us have regular access to our stress relieving hobbies.’
Splitting staff into teams at work usually also means no contact between teams outside of work.
‘There were genuinely tears after the last ‘normal’ shift as people realised they may not see some of their friends for weeks, months even.’
Before Covid-19 brought added work stressors with it, vets were already at a high risk for mental ill health. This knowledge weighs heavily on many of us:
‘I’m concerned that abuse of controlled substances will increase and don’t even want to think about the suicide issue the veterinary industry already faces.’
Vets appreciate the many clients who are doing the things that make their work less stressful, such as practicing social distancing, being patient when things take longer than normal, and assessing what might constitute an essential phone call.
For example, now is not the time to phone your vet clinic for a lengthy discussion about which breed of cat you should get.
‘If the public can show extra understanding towards vets and vet nurses that will only be a good thing. We are not the only profession under strain but the pressures we are under are very real. Everything is taking longer so people need to be patient.’
‘We place a lot of blind faith in the honesty of strangers at the moment…I feel angry when I hear of my colleagues having got to the end of a consult only to have a client mention that they just came back from a cruise a week ago.’
‘Thankfully 99% of our clients are understanding and adhering to protocols without complaint, but I don’t think they quite understand how hard everything is for us right now.’
‘The shortage of equipment is tricky – no hand sanitiser, limited paper towels and gloves. It makes it hard to follow the guidelines to use hand sanitiser between every patient. Some human medications we use are in short supply, which will be hard to explain to clients when their pet’s medication needs to be stopped suddenly.’
‘We have also been asked to supply a list of things we can donate if needed – such as ventilators, propofol, midazolam, and surgical gowns and gloves.’
What is getting us through?
Now more than ever, humour, teamwork and appreciative clients balance out the challenges of veterinary work.
‘On the positive side of things, I work with a group of amazing humans and the way we all have each other’s backs has definitely shone even more so in recent times.’
‘On the upside we have always been good at the ‘make do and mend’ mentality. Also, we were born for this – we just need to pretend every person is a parvo puppy!’
(Parvovirus is a highly infectious, potentially fatal viral infection, most common in puppies, and requires full isolation nursing.)
‘Our team are amazing and have chosen to pull together with a plan to fight and minimise risks to client and staff safety, mitigate risk to the business and work toward sustainability.’
‘We have had wonderful support from our clients and community who have commended us for our initiatives during this pandemic to ensure both human and animal welfare,’
To conclude I will reach for words one of my close vet friends passed on to me. Even though upper management of veterinary practices, can be notoriously out of touch with the needs of its veterinary workers, this directive from the upper management of my friend’s practice encapsulates perfectly what I would want all vets working through this pandemic to hold close to each day, and what I would want all veterinary clients to be aware of and respect:
‘Throughout our career, veterinarians have always put our patients first, then our clients, then ourselves. In this pandemic, we must put our safety and the safety of our nurses and support staff first.’
The Covid pandemic feels as though it has equalised our collective mental health. Or if not equalised, then it has certainly ‘flattened’ the mental health curve.
Most people who live with a mental illness have at some point experienced unpleasant times with no fixed end point, over which they have little control. And now the rest of the world is being forced to experience this too.
I imagine everyone’s mental experience of this pandemic differs based on their mental health history (among other factors). But it’s fair to say that right now most, if not all, of us are experiencing some form of mental discomfort.
On the surface, those who live with mental illness appear to be most vulnerable to this. But, this demographic may not be as at risk as we think.
As someone who lives with a severe mental illness but is currently relatively asymptomatic, I feel surprisingly resilient…for now.
Having previously lived through the rock-solid horror of psychosis, the inevitable Covid anxiety that flits through my brain now feels relatively easy to manage. I have an arsenal of finely honed tools to combat it. All that Cognitive Behavioural Therapy, the Acceptance and Commitment Therapy, and individual sessions with my psychologist are coming in handy.
I am also familiar with having my freedom restricted at times. When I am on fifteen-minute observations in hospital, I can’t go outside. At my sickest I have been too unwell for visitors. It doesn’t mean I like it, but I have at least previously encountered similar conditions to the ones I am living with now.
But what about everyone else?
Many people had been living with mild to moderate undiagnosed or poorly managed anxiety and/or depression for several months or years before Covid hit. I am particularly concerned for this group.
They don’t have solid medical and social support systems in place yet. The all-encompassing Covid generated stress is the perfect trigger for worsening symptoms. And accessing good mental health care quickly and efficiently may become even harder than it usually is.
Depression and anxiety symptoms can make the sufferer feel isolated even if they are closely surrounded by loved ones. Social distancing – so essential to manage virus transmission – will exacerbate symptoms of mental ill health in this group.
Then there are the people who have never lived with mental ill health.
They may never have experienced racing thoughts, heart palpitations, chest pain, irritability, distractibility, gastrointestinal signs such as nausea, vomiting and diarrhoea due to anxiety, a low mood, insomnia, incessant worry, or any other mental and physical symptoms that can arise due to stress and/or mental ill health.
These people may not know why they are experiencing symptoms or have the psychological skills to put them in perspective. So, they will suffer more than they need to.
But there is good news in the quagmire of black headlines we are sucked into daily.
We can use our own mental health histories to help ourselves and others in this crisis.
If you live with mental illness and are currently symptomatic, your sole focus must be to do what you can to get well. I know from my experience I am of no help to anyone if I am symptomatic. It’s a cliché but one that applies here:
‘Put your own oxygen mask on before you help anyone else with theirs’.
Firstly, contact the medical professionals you would usually consult when you are symptomatic – whether that’s your psychiatrist, psychologist, GP, community health workers, or psychiatric hospital.
Limit your exposure to the news to once a day – if that. If you have family or friends who can reliably update you on the essential news only, do that. Immersing yourself in the details, is of no practical value, and it can make you feel worse.
Use the same tools you would usually use to distract yourself when you are living through an episode of illness. Eat regularly and well. Don’t consume alcohol or recreational drugs. And move your body in some way, even if it’s small, every single day.
If you live with mental illness and are currently asymptomatic be vigilant but not obsessed. Just because this time is stressful, doesn’t mean developing an episode of illness is inevitable.
Your oxygen mask will consist of continuing to take medication (if you take it), keeping your regular appointments with your psychologist, psychiatrist or GP where possible, eating regularly and well, exercising most days, avoiding or minimising alcohol consumption, and practising whatever psychological skills (for example Cognitive Behavioural Therapy) that you have learnt over the course of your illness.
Be aware of any news developments that have practical ramifications for you, but don’t marinate in the news. Once you have done all this and whatever else you need to stay well – consider this:
You can offer support to those who are struggling mentally, those who have never experienced symptoms of mental ill health. Reassurance that their symptoms are survivable with the right care, could mean a lot to someone who is new to these issues.
That said – only do this if you have the mental energy to spare – otherwise just look after yourself.
To those who sense they may have been living with anxiety or depression for a while and it is worsening: All the suggestions with regards to eating well and exercise apply. Don’t self-medicate with alcohol or other recreational drugs. It will make things worse. Getting the right help is also crucial.
I am acutely aware that accessing good mental health care is a challenge in this country even when we are not mid crisis, but some excellent online resources to start with are: Lifeline, Beyond Blue, and SANE (Links at the bottom of this post)
To all the people who have never lived with mental illness: Distraction, exercise, eating well, and maintaining social connections via technology are a good start. Don’t self medicate with alcohol or recreational drugs. If you are still experiencing symptoms related to anxiety or depression (as listed above) then the online resources at the bottom of this post may be useful, or make an appointment with your GP as a starting point.
And one more thing…
Once you have done what you need to help yourself – take stock of how this situation is making you feel. And then imagine feeling like this for much longer periods of time than this pandemic will last.
Imagine feeling like this but the pandemic didn’t exist and people around you made you feel as though your symptoms weren’t real.
Then translate your feelings into compassion. And when you feel like yourself again (and you will), extend some sympathy and support to those whose mental illness lasts a lifetime.
And to everyone: We can use our individual experiences of mental health and ill health to support each other through this strange new world and into a kinder future.
So look at who you are sharing your living space with at the moment and consider starting a conversation about where on the spectrum of mental health and illness you and your housemates or family sit. Then think about how you could help each other psychologically.
My own household is one of extremes (regarding the adults). I live with severe mental illness, currently asymptomatic. My husband has never experienced mental illness.
So, when he expressed frustration a couple of days ago about his attention span feeling like that of a gold fish, I said:
‘Yes, I know it sucks feeling like that. But it will be ok.’
And I gave him a hug – something which I believe (at the time of writing) is still acceptable and safe to do in a household in which no one is symptomatic or has returned a positive Covid test.
This post is based only on my own experience and anecdotal evidence.
For professional mental health advice please contact your psychiatrist, GP, or for more mental health and ill health information check out the following links, all three of which are currently set up to deal with questions about Covid related mental health issues: