Crazy Beat

So over the last 10 days I've been to hell and back.

I intend that the contents of this post will be dissected and prepared for publishing to somewhere with a wider audience.  I'm not sure how to do this while still maintaining the privacy of my brother, but I guess I'll have to think about that nice and hard.

Living with a family member with a mental illness is really difficult.  Especially when that illness is exacerbated by addiction.  Especially when the addictive substance causes psychotic episodes, and is legal and accessible in Victoria.  I want to wax lyrical about the dangers of synthetic cannabinoids, how fucking ridiculous it is that we haven't successfully made them universally illegal in this country, how they're readily available in most sex shops, and how cannabis is probably a far superior drug to have circulating and regulated.  But perhaps another time, and in the presence of people who can actually do something about the law.

Either way, cannabis and synthetic cannabinoids make my brother severely psychotic.  And he loves them.  They make him extroverted, generous, exacerbate his creativity, drive the energy behind his thoughts.  It also makes him completely uninhibited.  This is a long standing problem, and we have our experience of attempted suicides, financial blowouts, violence, traumatic emotional breakdowns.  My mother has experienced him swaddling himself in towels and sticking his thumb in his mouth, demanding to be returned to the womb.  My father has caught him as he tries to slash his wrists, and driven him to the emergency room, bleeding everywhere.  He has disappeared for four months, found sleeping under a bridge in New Zealand, with nothing but a burnt up passport and a bong.  His depressive phases are just as painful, where all he does is eat, sleep, and cry, for months at a time.  It has impacted on all of us in different ways.

My brother has been well since the start of 2013, and it has been a wonderful time in which he has returned to study full time, we have travelled to Malaysia together, and he has had a modicum of stable happiness.  About 3 months ago, he asked me to start managing his money, so that he didn't spend too much, and I have been metering out his cash to him on demand, no more than $100 at a time.  I thought not so much about it.

The last few weeks, however, my brother has progressively been becoming hypomanic.  He's been organising a film project for his course, which has expanded from a four minute scene of a film, to plans of a full movie length reshoot.  He bought a new camera, a new skateboard.  He flew to Hobart on a whim, and spent more than $2000 in 4 days.  I returned to my apartment one morning and found all the booze (I don't drink, I occasionally get bottles which I save to re-gift) in my apartment consumed, and all my clothes in my room stacked in a corner.  Sleep was evidently becoming scarce, his speech has been getting faster and hard to follow.  Vague magical thoughts emerged in his speech, where the number of missed calls to his phone were suddenly directly related to his fame and success.  Epiphanies of the future of film, where we might soon all wear 360 degree globes around our heads for a full 3D experience.

Saturday night, when he got back from Tasmania, at my folks house, I was going to work, and went to say good evening to him.  He was in the basement with the dogs, smoking a spliff.  He declared that the contents were damiana only, however when he showed me the pack, he tried to hide the packets of synthetic cannabinoid.  I called him out on it, and he gave me the packets, asking me to get rid of them.

He came over to my apartment the following evening, as he had class on Monday morning, bringing an old tube television and other props for his film shoot.  I woke early in the afternoon to spend time with a friend, and wanted another nap before my shift started at 9pm.  He arrived at 7pm, talking quickly, asking for a small amount of money to see some comedy in town.  I took him for some food, and left him with $40.

When I got home on Monday morning, after working in critical care nursing all night, I found my one bedroom apartment trashed.  The flat screen television had been kicked in, there was washing powder from one end of the apartment to the other.  My fridge and freezer were empty, there was a pot on the stove with 3 litres of muck; in his inspiration, he had made "curry soup".  He was passed out, half on the couch, mouth open, snoring loudly, with nothing on below the waist.  I admit to usually being quite untidy, my living space generally has some level of clutter, textbooks, notepads everywhere, and a chronic inability to work out how other people keep tidy systems in place.  But this was something else.  Clothes, electrical equipment everywhere.  There was some evidence that he had attempted to clean up after himself.  The vacuum cleaner was out.  He had hidden the flat screen behind my shoes and unhung paintings.

I woke him up, but he kept drifting back off to sleep.  Clearly something was wrong.  I rang his private psychiatrist and left a message.  I rang my parents.  I rang the emergency services and asked for the police and an ambulance.  I double locked the back door so that the only escape was through the front, and through me.  I waited on the front step.

The police arrived first.  My brother woke up, and presented as very reasonable.  He admitted to taking 10mg of Olanzapine yesterday evening, then 20mg an hour before I got home.  He put some pants on, and I showed the police the damage.  They seemed unconvinced that there was a significant problem, and asked if I wanted to cancel the ambulance.  I stated that under no condition should they cancel the ambulance.

The ambulance arrived next.  The paramedics have a great deal more training, and my brother started to get mildly verbally abusive.  I promised him that I would be at his side 100 per cent of the time, because I know that he just needs to get through this current phase.  When we piled into the ambulance, he became very verbally abusive, upset that I was intentionally about to ruin his life.  We were warned that the emergency room was "busy".  I had been looking at the waiting room at my place of employment not 2 hours earlier, and I knew that the EDs were quiet, as our cubicles were more than 50 per cent empty.  I asked that he be taken to that hospital, but the paramedic declined, citing that their obligation is to take patients to the nearest hospital not on bypass.  We arrived.  They kept him out in the ambulance waiting bay, I completed the paperwork at the triage desk, and my parents arrived, looking exhausted.  My mum had also worked the previous night shift, and was supposed to be celebrating the commencement of four months of long service leave.

The private psychiatrist called back, and I gave him a run down.  When told he had taken 30mg of Olanzapine, Doc asked if he was trying to kill himself.  He agreed that my brother was probably requiring hospitalisation, and intensive psychiatric care.  We arranged an appointment for Wednesday evening.  That left from Monday morning until Wednesday evening to find alternative support in the public system.  Doc stated that he would do everything to get bro into private hospital sooner, and asked for regular updates.

My brother was seen by the emergency registrar, who brought him out and queried the location of his place of residence.  Because if he lived in suburbs with my parents, he was another suburban health system's problem.  Or if he lived in his privately owned property, he belonged to the Country District Catchment.  He certainly did not live in the catchment of the City Hospital, and should be discharged into the community to seek care at a more suitable location.

I put my foot down.  My brother lives with me five days a week during semester, well within the boundaries of the City Hospital's catchment.  He clearly currently needs care, he needs to be seen by the psychiatric team.  Neither my parents nor myself were willing or able to take him home and ensure that he is safe.  To be discharged at this juncture would be a breach of their duty of care.

It was 10am on Monday morning, and I had been awake for 18 hours.  I thoroughly lawyered the shit out of them.

They nodded and grumbled and headed back into the ED, stating he would be seen in due course.  My brother curled up on the chairs in the waiting room and fell asleep.  He woke up and demanded cigarettes, of which there were none.  I ran to the local shops and got him a pack, some ginger ale, and a breakfast energy drink for myself.  I hadn't eaten since midnight, and sleep wasn't on the horizon.  My brother spat some more abuse at me, completely ignored my parents, had a cigarette and went back to sleep.  My mother left in disgust (and has not spoken to my brother yet since).  My dad had some chest pain, resolving with comfort and a couple of cups of water.   The waiting room became completely empty.  The registrar arrived about an hour later, looking a little sheepish, saying his consultant had told him to treat.  My brother was taken into the cubicles, where he again very promptly passed out.  We had spent four hours in the waiting room, waiting for treatment.

Having frequently worked in ED, I knew that my brother was safe and unable to abscond without a proper struggle.  I cried with exhaustion, joy, and grief.  My poor father only ever sees me depressed cry over my failed attempt to have an actual law career, so the hysterical anxious sobs were something that he had previously never experienced.  We took the tram back to my apartment, surveyed the damage, found where my brother had parked my dad's ute, parked it somewhere more legal, and went to a local cafe for coffee and food.

It gets patchy after this because my recollection of events after being awake for 20 hours is always hazy.

I was keen for my father to go home.  We didn't know what was about to happen, but I needed to sleep.  I called the hospital, and got put onto a rather hostile mental health nurse.  He was pleased that I called, and started to collect a history from me.  I remember at one point, I mentioned the words "mood disorder", to which he asked "why do you think that he has a mood disorder"?  This somewhat shocked me.  I had previously stated that I was a registered nurse working in critical care, with experience in mental health nursing; to have my authority questioned, after 21 hours awake, seemed entirely unnecessary.  He told me that my brother is sleeping, and wouldn't be discharged any time soon.  I hung up, sent my dad home, and went to bed.

I later found out that he had yelled at, and hung up on my mother when she told him that she felt unsafe taking him into her care in the suburbs.  How very professional.

I slept from 3 to 4:30pm.  I woke to the phone, the mental health nurse telling me that they were ready to discharge him.  He told me that my brother was not sick enough to section (administrative detention under the Mental Health Act), and I agreed with this assessment.  I asked him to call back, so that I could review the situation with my parents.  I called the folks, and they seemed ambivalent either way.  So I spoke again to the mental health nurse, and agreed to accept my brother, on the condition that he be reviewed by the local Crisis Assessment Treatment (CAT) team that evening, and have his anti-psychotic medication supervised twice per day.  He agreed that this was an appropriate discharge plan, and that it would be in place when I collected my brother.

I arrived at the ED at 6:30pm, and the mental health nurse told me that the CAT team was too busy, and gave my brother his evening dose of anti-psychotic.  I shrugged this off as the overloaded healthcare system, and was given assurance that he would be seen in the morning.  I took my brother home.  To my horror, he mentioned that his overtiredness was probably due to taking 300mg of slow release Quetiapine.   I ate his awful curry soup with him, put on a movie on his shitty old television, and he fell asleep.   I went to bed at 9:30pm.

The next morning I woke at 5am, and my brother was already awake.  We walked through inner suberbs, about 8km, having breakfast at a nice cafe, taking photos.  It was hard rubbish week, and I had to work hard to stop my brother from picking up every shiny thing we came across.  My brother explained the night before, saying that he had "just gone crazy", and couldn't explain away the chaos.  He had smashed the television, thrown around the washing powder, then gone to a city pub to do a stand-up comedy set.  He had come home and made the soup, then had a bath.  He had tried to inhale the mousse in my bathroom in an attempt to get high.  He had used the $40 to get more synthetic cannabinoid, and it had made him crazy, and he desperately wanted more.  I spoke with my father, who had a medical appointment down the coast, planning to tag along from midday, and spend the afternoon at the beach.  We were home before 9am, and waited for the CAT to arrive.  They didn't.

My brother started watching YouTube videos.  He was smoking spliffs.  He moved to another room, playing music at top volume.  He turned on the old tube television.  Noise from every direction, completely chaotic.

I called the relevant mental health treatment team around 11am, stating my name, my brother's name, and asking what was happening.  They seemed to have no idea who he was.  They asked me to take him into their office so that they could assess him.

We arrived at the clinic at 11:30.  A psychiatrist and a mental health nurse came to assess my brother, first asking to speak to me, without him present in the room.  I again gave them a full run down of the situation, as well as a brief history of his illness.  I again asked specifically for a team to assess my brother and supervise the administration of his medications twice per day.  They then assessed my brother, who looked paranoid and asked that I leave the room.  20 minutes later, they emerged, stating that they were happy for my brother to continue on the anti-psychotics prescribed, gave him a script, and planned to send him home with no supervision.  I became angry and asked to speak with the psychiatrist individually.  I asked the psychiatrist if my brother was not unwell.  He stated that my brother was clearly unwell, but all he needed was the medications.  I drilled down and stated that I was unwilling to take him home without the assessments and supervision from the CAT, as promised by the team at the emergency room.  I stated that this was an unethical and inappropriate plan, especially given to someone clearly in a psychotic crisis.  The psychiatrist agreed, and disappeared, sending back the mental health nurse to discuss further.  I cried at the mental health nurse, stating that I have the full intention of making a complaint at the low standard of care.  He told me that they were going to make contact in the late afternoon and complete the assessment at that time.  I remain unconvinced.  He gave me the complaints information.

We had missed the trip to the country, so I took him back to my apartment, where he continued to smoke spliffs and watch YouTube.  I was tired, and napped on and off.  We went into JB HiFi, and he was horrified to find out that the replacement television would cost more than $800.  The CAT turned up and supervised his medications.  We went out for dinner, though I cannot remember where.  Again we threw a film on the tube television, and he fell asleep.  I threw a blanket over him and went to bed.

The next morning I again woke at 5am, and he was already awake.  It was pouring with rain.  He had been up since 3am editing a project for class.  I called my mother to give her an update, to tell her that everything is okay.  She told me that my brother is not welcome at her house, that I must start to charge him rent, and that effectively he is my problem from now on.  She directed me to tell him this.  I did, and it didn't seem to sink in; he changed topic to something much more unrealistic and optimistic.  He announced that he intended on attending class all day.  I agreed, and took him into his university.  His class started at 9:30am, I dropped him off in the classroom, where they were watching a film with a closed door, and went to get a coffee and make some phone calls.

The first person I called was the psychiatrist's office.  I spoke with the receptionist, asking when a bed would be ready for my brother at the private hospital.  She stated that he would not get a bed until he was assessed by the psychiatrist.  The full weight of being completely devoid of hope that help would arrive started to sink in.  I started anxious crying.  I told her that I wasn't coping, and that the hospital could soon expect two admissions rather than one.  She said that she would call back shortly, and I hung up.  I cried for 20 minutes, put an awful cry-for-help post on Facebook and Twitter, ordered a coffee, and cried for another hour into that coffee.  Finally the psychiatrist's office called back with the news that there was a bed available, giving me hope and a path out of the mire of helplessness.  Knowing that he must consent to being admitted, I pulled myself together and went back to his classroom.  A couple of friends called, and I felt a little better.

My brother went into the private hospital without any struggle.

I have complained to the hospital in question, the Mental Health Complaints Commissioner, and the Chief Psychiatrist.  I have only heard back briefly from the hospital, and the complaint is being heard by the MHCC.

He is better now, his bipolar is being treated, he is addressing his addiction problems, and he is keen to get back into the world.  His discharge will be tomorrow.  He is sad that he cannot take the drugs, but has a wonderful psychiatrist that has incorporated him in his own care every step of the way.   Mental health care in the public system seems to allow for, nay, encourage patients to fall through the cracks at every step of the way.  I am grateful that he is being treated in the private system now, and will endeavour to ensure that he stays under the care of this psychiatrist.  We are optimistic that this is a glitch, and as long as he can stay sober, this will not spin into the regular shitty manic fuelled hellish avalanche of psychosis and bridge burning.

(It's was not a glitch, he has since been admitted to a much better public health service, and is getting the care that he needs.)