When a Psychiatrist Isn't a Good Fit for Your Family Member

Desperate101 · ‎28-08-2016

I have a sibling who has been under the care of her current psychiatrist for about 12 months and the family feel very frustrated with him as we have no improvement with her - in fact things are getting worse. She is seen in a psychiatric clinic and the place is just one revolving door with her now so medicated that she is out of it a lot of the time. She also has a substance abuse issue mixed with anxiety and depression so her issues are three-fold. He has now allegedly told her not to listen to her family (we want her to seek treatment at another location with a longer term residential structure). The problem that we have is that the psych only knows what she tells him which is undeniably quite different to how things are for her family when she returns to her own environment and her behaviours return in a matter of days. If we don't intervene and get her back into the psych hospital, she would die as all she cares about is wiping herself out. Isn't there a code that psychiatrists have to adhere to which would mean that if they are not seeing an improvement in their patient over a period of time, that they refer them on? What can a family do? Genuine advice sought please.

Cornstarch · ‎28-08-2016

Oh man that is such a tough question because they are so over-worked and thin on the ground. I mean people can suggest just get another one but that is not realistic depending on where you live and who is available.

It is a fraught thing when an adult is dealing with a doctor and only has the information that that person is giving them. I got really frustrated with a friend that blamed the doctors and nurses for not picking up she was bulimic. She bagged them out, and refused to disclose. Even though her depression was horrific and she'd had ECT, the whole works. And she still refuses to tell them. I don't understand that when she said she was desperate.

Does she have a partner? They may be able to swing the privacy thing a little easier than others.

romantic_thi3f · ‎30-08-2016

Hi Desperate101,

Thanks for posting and I'm sorry that you're in this situation.

As far as I am aware, there is no law that they have to refer the client on if they are not seeing functional improvement. However, if they believe the client is at risk of harming themselves or another person, then by law they can't ignore it. Also, ethically and morally if they feel they have been working with the client and they are unable to offer help then yes - they should refer them on.

Do you chat much with your sister? Trying to get an insight into what the psychiatrist suggested and recommended can help - and often psychiatrists can allow family members to contact them or sit in on appointments so that it can be a family orientated recovery.

One thing that might be helpful is chatting with her GP (that referred to the psychiatrist). This way you can express your concerns about her safety and then the GP can then consult with the psychiatrist. Your GP may even suggest referral to a different psychiatrist; your sister certainly has the right to request one if she feels it's not helping.

Hope this helps

Dr_Kim · ‎01-09-2016

Hi Desperate101,

This is a very sad situation for all the family.

It is sometimes really frustrating for family when they don’t understand how a loved one’s health professionals are thinking and what their plans are ,and due to privacy they cannot have access to them to talk about it.These privacy boundaries were devised for good reasons but can really frustrating at times. Often, the professionals involved are actually pretty good and do in fact have a plan, its just that you can’t see what they see and know and visa versa.

However, there are good and bad health professionals and if you really feel that your loved one is at risk from a sloppy health professional , there are a few ways to tackle it.

I might suggest a few things:

1. Try talking to your sister about your concerns and see if she consents to you coming with her to the psychiatrist and voice the families concerns to him directly.

2. Try talking to your sister and see if she will consent to a “ second opinion” . Ask her if fresh eyes on the situation might be valuable for everyone concerned.

3. Try talking to the GP and see if they can assist you with bringing the concerns to the psychiatrist

4. Put it in writing . Put your concerns down and send a letter to the psychiatrist and copy it to the GP so everyone is clear what the issues are and what the family feels is best . Ask for a clear explanation of his treatment plan is in a family meeting . It may be that once it is explained to you clearly , you may in fact all agree!

It does sound that your sister has a difficult and complicated history and there is no “quick fix” but I think everyone would feel relieved if the treatment goals and plans were more transparent.