18 March 2021

A toxic culture of permissiveness and inaction

Mental Health Psychology Women

I spent hours on the phone this week talking to busy hospital doctors begging for them to admit one of my patients.

She has been sick for years and has been in need of more help for weeks now as it has become too hard both for her and for us – her GP and psychologist – to manage the severity and distress of her complex illness in the community. We’ll get to that later.

I couldn’t attend the Women’s March on Monday. I wanted to with every fibre of my being and was excited and moved to tears to see the photos on social media from my friends and contacts who’d managed to get there. I was busy at work. I couldn’t bear the thought of taking a day off, because goodness knows where I could reschedule all the patients I’d have to cancel.

You see I work in primary care and specialise in mental health and young people and eating disorders. So I’ve been really busy lately. And on top of the pandemic stress and fatigue I’ve been overwrought and troubled by the recent media coverage of the alleged sexual assault of women in parliament, in our schools and of our young people. I see the impacts of these kinds of issues every single day.

The pandemic has exposed the cracks in our system. The system mobilised impressively quickly for a virus that threatens the very fabric of our society – affecting our vulnerable disproportionally we rally hospitals and ventilators, researchers and public health heroes to protect us from its scourge.

But we have heard stories these last few weeks of young women who have had their very core infected by another virus – of (#notall) men’s disrespect for their humanity and bodily integrity – and who have suffered from an indolent and toxic course resulting in diseases of their mind and body. It’s not “long covid” it’s “long rape”.

Like the brain fog and multi-system effects that are yet to be fully understood post COVID-19 infection, people who have suffered the trauma of assault and abuse experience long term and nasty problems. Like Grace Tame they can suffer for years with eating disorders that rob them of health and happiness. Like poor “Kate”. My heart bleeds for her that despite the loving support of friends and family she couldn’t see a system that could give her hope for validation and recovery. I wish she could have heard Brittany Higgins speak on Monday and to feel the emotional support of the crowd of people in Canberra and elsewhere.

Is it time? Is enough enough? What else will it take?

I wish I had the answers. All I can offer is my experience. As a GP with a special interest in mental health I ask for the system to understand that my patients need time and respect and understanding. They need care in their communities with people that know them and understand their context. They need services that manage their body and their mind as whole and to listen to their story rather than compartmentalising and blame shifting. We need to value generalism over partialism.

That way I wouldn’t have had to spend hours advocating for my eating disordered patient who was apparently not mentally at risk enough for a mental health bed, but luckily for her just physically sick enough for a medical bed.

Dr Karen Spielman is a Paddington GP, who also  works at headspace Bondi and is GP Consultant at InsideOut Institute.

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