I have two more appointments before my psychiatrist retires. This isn’t a surprise, she told me when we started three years ago that our relationship would be temporary. She also told me I wouldn’t be left out in the cold, that I’d be referred to another psychiatrist and my treatment would continue.
But that’s not happening. After our sessions are over, I’ll be assigned a psychiatric nurse, who will monitor my medications for a few months, then my family doctor will take over. If he can’t, or won’t, deal with me, he can refer me back into the mental health system where I’ll have to wait for six months to two years for another opening.
If… or when he refers me, I’ll have to go through an evaluation again where I’ll be expected / forced to advocate for myself… again. Which is something very few of us are good at. The time I’m without hands-on treatment will be determined by how the evaluation goes…
My time with my psychotherapist is also up. I was only guaranteed, I think, twenty-six sessions with her, and those are done as of our last appointment. She’s doing me a favour though, and still seeing me every ten weeks or so, just to make sure I’m not entirely alone. But that’s only going to last until the end of the year.
So my safety net is being taken away again. The last time that happened was in 2018, when the psychiatrist who first diagnosed me as having manic depression retired. He decided that I didn’t need to be followed by a shrink anymore. That I’d be okay on my own. I don’t think I lasted more than a few weeks before I had to ask to be evaluated to get back into the system.
I’m not angry about the situation. She has to retire, I know that. And she believes I’m stable enough… I mean, I’m not suicidal, and haven’t been for a while now. At least not overtly. I still have some pretty self-destructive behaviours, but I’m not looking at the pills I have and wondering how many I should take to end myself. And it’s that perceived stability which is the reason why I’m not being immediately transferred to a new psychiatrist.
There are just too many people on the waiting list for both psychotherapy and to see a psychiatrist. Based on the last time this happened, I don’t think my family doctor is going to want to be responsible for my psych meds.
So back in the pool I go.
…one of the things my psychiatrist and I did talk about was my dreams. I’ve been having a recurring dream for roughly a year now. In it I find my friends — generally people I hung out with twenty or more years ago, in weird locations and we hang out and party for a while. Usually in a house or apartment I’ve never been in before. Then I turn my back, or get distracted, and when I turn back they’re gone. I spend the rest of the dream trying to find them.
For the past few months I’ve had a version of the dream at least four or five nights a week.
She asked what I thought was happening in the dream, but I’m not very good at interpreting dreams — but I don’t have a lot of IRL Friends anymore. I do see people I know when I do go out, I live in a pretty small village. But the time of getting together in the evening with Friends is over. Most of them have moved away, and the ones who stayed have their own lives to lead…
…we also talked about my Meds. She wanted to reassure me that I’d have enough refills for the year. She also bought up the idea of switching to Latuda, or maybe simply adding it to my pill diet. But I’m trying to keep my regimen to as few pills as possible, I don’t like the idea of taking pills to counteract the side effects from pills I’m already taking.
She asked about the Trintellix — it’s supposed to help me stay up during the day. I’ve been taking it regularly since, roughly, January. Recently, like the past week or ten days, I’ve noticed that it’s easier to stay up in the morning. Instead of going back to bed after I get the kids to school, then waking up at 2pm and rushing around, I’ve been getting things done before noon.
I’m still tired, I just can’t sleep. It’s a very odd feeling.
…I’ve been lucky to have the Doctor’s I’ve had — to have had the care that I’ve had, especially over the past few years. I just don’t like the idea of being on my own… of having to deal with this on my own.
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...salted lithium. 
Well, I’m pissed. Your psychiatrist owes it to you to make sure you’re set up with a successor before she retires. Another psychiatrist, not a psychiatric nurse. And you shouldn’t have to go to the back of the line and start over again when you’d already gotten to the head of the line and into the care you sought. (Don’t mind me. I’m a doctor’s kid and very opinionated about the profession.)
Meantime, heads up and carry on. Your boys need you.
Thanks Susan. I think I’m a little pissed off as well, but I’m more resigned to the process. The decision has been made, and there’s just too much demand and not enough capacity. This region used to have an inordinate amount of psychiatric doctors, but they’re resigning and not being replaced. I know, from past experience, that my Family Doctor doesn’t want the responsibility (or have the time) to deal with my psych-meds. So I’ll have to do the referral questionnaire again, and hope that I can get back on the waiting list.
Thanks again for the comment, Susan.
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I feel your pain. It’s so frustrating isn’t it. It seems like everyone has the mindset of acknowledging the fact that you have a mental illness but you have to act as if you don’t! I’m currently going through the process of getting a routine in my life. Sleep 10pm till 8am, 3 meals a day and so on and so forth. Great, if you don’t have a mental illness then you’ll achieve that no problem. How can I sleep when I’m not tired and I’m manic? I’m in bed but staring at the ceiling. It’s these hours when there nothing that my voices are at their loudest! I can prepare breakfast, dinner and tea when I am supposed to, it’s something else if I can eat them! How can you eat when you’re not hungry?!? In the uk you have your referral to mental health and illness professionals. If after you are stabilised, 12 months more or so, you are referred back to your GP. Only recently if you relapsed you were put back on the waiting list. Now you get back to where you were previously. But as you said, you have a rapport with your current care provider. That’s invaluable. I’m too, blessed with my own point of contact. The thing is, as you know, our afflictions don’t have a timescale to which they work on. You could be 6 minutes, 6 weeks, 6 months or 6 years away from something popping it’s head up to disrupt your day. I feel your pain and frustration my friend. I also wish you all the best and hope everything goes smoothly and as well as it can. You’ve got this 💪
Hi Rochdalestu… it is frustrating, you’re right. The only way I was able to set any kind of routine, especially sleep, was through medication. I have a friend who uses weed — in gummy form — to sleep, and she swears by it. But for myself, I use a small amount of Seroquel (50mgs) to shut the voices off so I can get to sleep, and a medium amount of Abilify (17mgs) to stay asleep. If those aren’t working, if the voices are too loud, I’ll take 5mg of Zoplicone and that gets the job done… and it’s non-addictive.
As for getting up in the morning, and eating at regular intervals, those are things I’m still working on. I’ve just begun to put aside specific times to do laundry and get the dishes figured out, but that’s still very fragile.
…the way it worked here, until recently, was the Psychotherapist decided when your time was up. Whether it took a year, two years, or ten, it was the Psychotherapist who made the determination. But because there just aren’t enough of them, and instead of figuring out a way to hire more, the Provincial Government has capped the amount of time a Psychotherapist can spend with a patient at 26-weeks. Then, whether you’re prepared or not, you’re tossed back out until you can get another referral. Even then, you’re not guaranteed the same Psychotherapist.
So far, the way it works with a Psychiatrist, is it’s up to the Doctor to determine how long you’re seen by them. Or how often. Even if they decide you’re fit enough to be on your own, they’ll ween you off slowly. In my case, because my Doctor is retiring, and there just aren’t enough spaces available, so I’m going to be on the outside looking in…
But, whether it’s a Psychotherapist, or a Psychiatrist, there’s really only two ways into the Mental Health system… one is through a Family Doctor, and those are at a premium in Canada right now. I believe the current statistic is 1 in 5 Canadians don’t have access to a Family Doctor. The other is to present yourself in the ER and hope you can get seen by a Regular Doctor who sympathizes with your condition.
Thanks for the comment, Rochdalestu, it’s appreciated very much.
I know very little about your health care system. From what you’re saying, it sounds like mental health needs aren’t handled very well. What you’ve described sounds adequate if someone has temporary anxiety or depression, but we have chronic illnesses that have to be managed forever. Would they kick someone out of physical therapy if they still couldn’t walk after a serious leg injury?
Are there truly no more doctors left in Canada, or is a lack of funding causing a shortage? If there were more money available for paying doctors better, wouldn’t the system attract more doctors? Also, you’re talking about the publicly funded health care system, right? Are there also people who can afford private insurance, and do they have problems seeing doctors?
I’m sorry, I don’t mean to quiz you on governmental or health care policy. I’m just shaking my head at the nonsense of leaving you without a psychiatrist for up to two years. I hope you will do okay.
Hi Rob. The two-year thing is not entirely accurate. If there’s a non-life threatening but desperate need to see a psychiatrist, at least around here and in my experience, the wait is about six months — after the referral and the intake questionnaire. It’s closer to two-years if the problem is less… desperate, I guess.
For example: my previous psychiatrist retired a few years ago — after being my Shrink for almost 20-years (off-and-on), without setting me up with another one, he thought I could get by with only my family Doctor. Which didn’t happen. After a referral from my family Doctor, and answering the intake questions, it only took a few months for me to get a new psychiatrist [link].
…Canada’s ‘health care’ system is a little weird in that there are actually ten different health care systems. Health care, according to our Constitution, is a Provincial responsibility. Each Province has their own unique properties. Some medications, for example, are covered under a Prescription Program in one Province, but not another. So a shortage of anything in one Province doesn’t necessarily mean there’s a shortage in the other nine.
The responsibility of the Federal Government lies in maintaining national quality control / standards, and a certain percentage of funding.
The current “doctor shortage” in this country is a problem created by the Provinces, most of which (I could get in trouble for this one) are led by Conservative governments who are definitely interested in creating a ‘two-tiered’ system — a pay-for-play for those who can afford it, and a less funded public system for the rest of us. Kind of like in the States. The Provinces, for example, set the number of doctor-residency programs, and they’re tightening the number, not increasing it.
And that definitely creates a shortage of Psychiatrists. Our little regional mental health centre, for example, had seven psychiatrists a few years ago. Now we’re down to four, maybe five. When mine retires, it’ll be one less.
Private insurance is something I don’t know a lot about. Like ManuLife or SunLife will cover therapy sessions, but psychiatry appointments — as far as I understand, are made through the Public System. It’s something I’ve been meaning to research more.
Good questions, Rob. Thanks for asking them.
Thank you for answering! It’s interesting to learn more about your system. All I hear is what our politicians argue, for or against, which is never accurate or complete information. .. You’re right about having a two-tiered system here. Many people need the federal insurance plan (aka “Obamacare”) because they have lower income or part-time jobs without benefits. The Republicans unsuccessfully tried to kill the federal government insurance plan, but they will try again if they win the presidency and get a majority in the House and the Senate. They don’t seem to care about the people’s need or wishes; it’s all about corporate profits for the private insurers and hospital systems.