GPs who reduce meds despite CTO being in place

[Attahua]

Hi, am really pleased to have finally found an online forum that is Australian based where not only can I vent but also ask questions and advice!! It has only taken me five years to finally find this 'safe' place! My partner of five years has schizo effective disorder, of course I knew this when I met him but had no idea of how much of a roller coaster ride it can certainly be from time to time, especially when he begins displaying those early warning signs!! Although this illness is nothing new to him....he has lived with it since he was 17, he is now 43 but even now after I have been through two major episodes with him, both ending in three months stays in a pysch ward, 6 hours drive from where we live, I do not feel he fully understands the impact it has on us as a family, not so much financially but it can be extremely emotionally draining as the one left at home to go in what I call 'damage control.' From the get go his extended family always told me I should never tell him exactly what he has done and said when he has been unwell but my therapist (as OMgoodness I have certainly needed one) has said it is okay to talk about the things that happened as she agrees that he does need to be aware of his actions to help him gain some insight and give him more reasons to stay well, this of course needs to be done in a calm repectful manner. However, that is not my reason for writing tonight. My partner has had the same GP for the past 15 years and he really likes him as basically any reduction in meds.....this GP will give it to him!!! This is despite the community treatment orders that have been put in place, although I know a GP has the power to reduce meds but one would have thought the moral thing to do would be to check with the mental health team and physciatrist first!!?? But no not this particular GP, he is known for hanging up on the Guardianship board and just doing what his client requests, regardless of whether or not it is in the best interests of the client and the client's family who are left to pick up the pieces. I would have thought the very least the GP would do was at least give me a call to see what my thoughts were on a reduction, and how I thought my partner was faring seeing as I , and my 15 year old daughter, live with him. But NO not this Doc he just does what he wants to do even though my partner's parents have complained to the medical board on numerous occasions. I guess my question is , has anyone else had these difficulties with doctors??? And if so, what more can I do??

[CherryBomb]

Hi @Attahua 

Welcome to the Forums, glad you feel pleased about joining. I hope you find the forums supportive and informative.

In response to the first part of your post, I think talking to your partner about the impact of his behaviour in a clam and respectful is a great approach. It helps raise his awareness, and shows him that there are consequences for certain behaviours.

Now to your main question. Hmmmm, I can't say that I know of anyone that has had this issue. But perhaps I can invite other carers who care for partners that might be able to offer some insights into how they deal with medication and health professionals. @Cazzie @Tatsinda and @3forme any words of advice for Attahua.

You might also find this thread about carers experiences with medication and the health care system interesting too.

CB

[-karma-]

Hello @Attahua

hmmm the conundrum!

Would your partner be open to you jointly attending appointments with the GP? I guess this could be part of the reflective process, in the hope that you could feedback the observations you have made, both when he is slipping, and during an episode, and that your partner would be open to this feedback as part of his overall recovery. I also agree that feedback is important. Ideally this would be done when he is well and receptive to the idea, in planning for future episodes, and what his and your expectations would be during this time.

Perhaps this might be better done with a therapists, the practices then applied to the GP appointment?

Alternatively, I am wondering if you would think about seeking further advice on this situation from, 'Mental Health Advice Line', which is in Victoria. It provides telephone advice, information and referral 24/7,

1300 280 737

or Vmiac (Victorian mental illness awareness council)? They have a strong advocacy role,

(03) 9380-3900

Check out the site here;

http://www.vmiac.org.au/

Hopefully this will be the next step in your relationship, and opens the way for more dialogue about moving forward.

[Attahua]

Thankyou so much for your reply! I think I would have more success going with him to his next psych appointment rather then meeting with his GP as last time I spoke to the gp was when my partner was in emergency after an episode and the GP basically just dismissed me when I was checking that he had told the nurses which meds he needed. He referred to me as 'she' to the nurses and then told them of the meds I was 'going on about!!' I also overheard a nurse question him on the high dose of sedative he wanted them to give him as it was high and he lightheartedly said'he can take it, look at the size of him" in reference to his height. I just found it all very unprofessional! However,should my partner end up back in hospital as a result of this reduction I will be very vocal about it as surely GPs have to be accountable as well to an extent!!! Especially knowing my partner's history of not taking his orals because 'he feels okay now!!!' Anyway, ATM he is taking his orals as well as depot but it is still early days!!! I will call the mental health advice line too!

[Attahua]

Thankyou!!!

[3forme]

Hi Attahua,

It sounds like you have been through a tough time. I would think it would be a good idea to attend the GP with your partner so you can get the family's point of view across, he needs to see the effect that your partner's illness has on the family.

It sounds a  bit unusual for a GP to adjust medication without consulting with the mental health team??

I also agree that your partner should know what happens when he is unwell. I know it can be a difficult conversation to have and there can be issues with guilt and wanting to protect our loved ones. I think its also important to know they are still loved, even when they are unwell.

I'm not sure where you live but your partner may want to complete an advance care plan when he is well? He can decide in advance what type of treatment, medications he would prefer if he becomes unwell. An advance care plan could give you some leveredge as the GP would need to justify their actions if the care plan is not followed.

[Attahua]

Hi and thankyou for your response. We do have a care plan in place stating what my partner would like to happen when he becomes unwell but the hardest thing for us is when I recognise early warning signs and he refuses to believe me and then when it becomes clear that he is in need of hospitalisation it is always a battle involving police and ambulances....it's actually very traumatic for not just my partner but my 15 year old daughter too. Fortunately his episodes are generally a couple of years apart and although this year is THE YEAR I am not anticipating that he will be hospitalised as he has been taking his meds (has to due to CTO) .....except now that the depot has been reduced and he still 'forgets to take his orals from time to time which is main reason for depot......with the lower depot dose chances are higher of a hospitalisation but I can't get my partner to see that reasoning let alone his GP as basically my partner then makes me feel bad because he tells me about how bad the side effects are on the higher dose etc......so all I feel I can do is support him, hope that the depot alone will hold him with occasional orals and if he becomes unwell (which is worst case scenario)then like every other time we will deal with that too! I just feel very let down with the mental health system full stop!! We live in a country town of 26000 and once again my partner's mental health worker has moved on....second one in three months!!!! We have only just got a full time psychiatrist at our local hospital and as part of my partner's CTO he has to see him.....so he did.....and the first thing he says yo my partner is...'what do you need to see me for???'....clearly he had not read the very lengthy thick file with the history .....the goal is to keep my partner well!!! Because he is called 'high functioning ' and works he is 'not a priority!!' ( those were the words of one of his past mental health workers when I rang with some concerns about his behaviour and was requesting that they drop in and have a chat with him seeing as they were meant to visit fortnightly at that stage but rarely did. Another time when my partner was in fact hospitalised (nearest psych ward is a five hour drive from our home) the mental health worker rang me to see how he was faring in hospital and he basically made the comment to me that it makes his job easier when my partner is in hospital because that's one less client he has to deal with for awhile!!!!!!!

[Ruth]

Dear Attahua ... you kindly wrote to me on 27 Sep 2015, but I have so much difficulty locating the thread of messages. I still can't find my postings and the responses, so I typed your name in the search bar, which led me to a different set of messages.  From this I see that you are dealing with a difficult situation, and yet you so kindly wrote to me with support. Thank you very much. You take care... Ruth x

[Sally]

Hi I have a parent who suffers from Schizo-Affective Disorder and the scenario you are mentioning is eeerily familiar to me.  My parent has a long history despite her illness of manipulating doctors into reducing her meds shortly after discharge from inpatient stays, which then usually leads to a very quick deterioriation in her mental state. My most recent experience is with their psychiatrist/ GP who after her last inpatient admission decided to reduce her meds within 2-3 months of discharge and remove her ITO, and we have been living with a roller coaster ever since.  In this case, I would have hoped for a Mental Health Tribunal Meeting so we as a family could formally address our concerns, but this doctor was able without informing any of us to write to the Tribunal directly and have the ITO withdrawn with there being no accountability.  Myself and another extended family member have since spoken with and written to this professional, indicating our concerns including that they have appeared to be quite unwell, and have been told that although they are still his patient that quote "It is not their problem", "That she didn't meet the criteria "(what criteria?) for maintaining her ITO status, and that if we have concerns that we will have to go through the whole process of having her involuntarily hospitalised all by ourselves all over again.  A friend who is a nurse and had some experience working in mental health has told me previously that threatening or taking legal action is the only way to make these professionals modify their behaviour.  Health Departments are notoriously useless for dealing with this issue in my opinion, but someone else reading these comments may have some useful advice.