Improving Mental Health Services: Lessons from a home visit

Raise your hand, if anyone else here tired of the whining and complaining that the government isn't doing enough for mental health services?

A few years ago, I made a house call late in the day, responding to a parent of a patient of mine who was unable to attend the clinic due to a minor domestic incident. The atmosphere was tense, like a whirlwind of emotions - that’s what the phone call felt like. The prescribed medication? It wasn’t working as expected. We were in the midst of it, with no choice but to endure. I asked if they could wait till I got there later that day - they agreed and expressed their gratitude. I asked why they didn’t call the crisis team - they did - they were advised to call the police (for an 11 year old having a tantrum). Understandably, she did not call the police. As for the rest of the family? I didn’t ask.

Upon arrival, I observed the mother, caught in this storm, unable to connect with the other kids or to prepare dinner.

So, what role does a psychiatrist play in such a domestic situation? I helped out where I could - I vacuumed the carpet, washed the dishes, and prepped the kitchen, all while trying to lighten the mood with some humor for the other kids.

The mother, understandably overwhelmed, was doing an excellent job validating and empathising with her 11 year old. Yes, tantrums can last several hours. It’s possible. Some clinicians suggest that tantrums usually pass in less than an hour, but for those parents who experience longer episodes, it can feel like they are the ones at fault or doing something wrong. This is why it’s important for clinicians to understand the realities of home life.

In the aftermath, as calm settled, we gathered for what I call ‘huddle wisdoming’. A bit cheesy? Perhaps. But it brings people together. ‘Tribing’ might be a better term.

I often reflect on these moments. I remember another instance - when a young man I treated, who had been made homeless after his parents had enough of his drug use, came to my clinic distraught. He hadn’t eaten in days. We drove to a fast food restaurant and shared a meal. He thought that was the most helpful session he’s had in years. Maybe it was because he got a free meal. Regardless, he called his parents afterwards and apologized. He still faces challenges, but that’s because he lacks a supportive community.

People need community, not just psychiatrists. We used to have tribes. Villages. We used to be together, rather than alone. That mother would not have needed to call a psychiatrist or the crisis team, if she had help for the everyday important tasks that fill our lives. My patient would not be homeless and hungry.

These may not seem like mental health issues, but aren’t they? How many times do we find that our interventions don’t work? How many times are we surprised when a simple act of community kindness changes the course of someone’s life and eases their pain? Parents having the time to connect with their kids? Substance users having a community to help them deal with the stresses and anxieties of the world so they don’t have to resort to quick fixes?

We need tribes. We need connection to nature. We need connection to our bodies. To each other.

Parents are the catalysts for change. Your deep understanding of your child’s history and the nuances of their world is a cornerstone for nurturing and support, an element that cannot be replicated within the walls of a psychiatrist’s office. But you need space. You need time. You need community. Not more psychiatrists. Especially those who prefer to stay behind closed doors while planning their next conference.

Rant over.