She was tapering him down slowly and warning and monitoring him the whole time, as per his wishes, so that he could find a level where he was able to actually function.
Is it her fault he chose to do illegal and inappropriate drugs against her advice?
Is it her fault that schizophrenia drugs suck and no one bothers to improve them?
At least he was in contact with a doctor, and was reducing his medication with her knowledge and advice, and actually seeing the doctor every now and then. (Until he wasn't.)
This is rare for people with schizophrenia. Mostly they just refuse to take their medication, and stop coming to see the doctor. The doctor can keep writing a prescription every X months if they want to, but the patient doesn't have to get it filled if they don't want to, and if they do, they don't have to take it if they don't want to.
Sometimes the doctor may see a family member for their own medical issues. "How's X? Is he taking his medication?" "I don't know. He refuses to talk to me about it. I tried to visit him last week, but he would not let me in the house."
Does he have a case worker or mental health coordinator at the public mental health service? I don't know. Nobody ever contacts the GP about him. Even if he ends up in hospital and then gets discharged in the middle of the night, nobody ever notifies the GP.
The doctor phones the public mental health service. "Does X have a case manager, or someone who is looking after him? Is there someone I can talk to about him?" "We closed his case a few months ago. We could not contact him, and when we did, he refused our help, so we discharged him from our service." There are thousands of other mentally ill people who need their services, after all. They cannot keep everybody on their books indefinitely, especially if the client does not want their involvement.
X is a public patient, so he has never seen a psychiatrist. I can't speak for Queensland or other states (I'm in VIC) but patients in the public system virtually never see a psychiatrist. It just doesn't happen. They deal with "mental health clinicians", nurses, social workers, or if they are really lucky and they are an inpatient in hospital, maybe a psychiatric registrar. One patient with schizophrenia has seen a private psychiatrist exactly once in their life. The family saved up money for ages to pay for one visit with a psychiatrist, in order to get an official diagnosis. In order to get a disability pension, the person must have a diagnosis of schizophrenia made by a psychiatrist. That's it. All other care and management is handballed to the GP.
If X has a mental health crisis and does happen to see the GP in that condition, the GP will phone the CATT (crisis assessment and treatment team) and spend an hour on the phone with them while an acutely psychotic and suicidal patient is in their consulting room or terrifying other patients and staff in the clinic, begging them to at least send someone out to talk to the patient (and maybe get them into hospital), while the CATT team is listing all the reasons why they can't/won't and the patient doesn't actually need their services. Or they will say to call the police or ambulance. The ambulance will not attend without the police, and the family beg you not to involve the police as this will agitate the patient further and they fear he will end up shot or otherwise harmed. Eventually he leaves of his own accord and goes home. You hope he will be OK. The CATT team may or may not phone him later at home. He may or may not answer or get involved.
I could go on and on. I could give so many examples. Because of privacy, I cannot.
In the meantime, X is experimenting with other "medications" which make him feel so much better than the ones the doctor prescribes.
And then if/when he does become completely unbalanced and harms himself or someone else, it's the GP's fault.
Once again, take this as my own opinion only - the random ramblings or fever dreams of a completely unverified individual.
I am going to take a break from this thread. It has been another one of those weeks in which you long for just one person to come in with a sore throat, or a sore finger, because EVERY.SINGLE.ONE of your patients is a complicated mental health patient and there is no room in the schedule any more for those other simple things. And you are not a trained psychiatrist or psychologist, or social worker, and can only do so much. And every time the government says "we will improve mental health services or support" it means "we will require the GP's to do more, without any extra funding, support or services."
And then, when the patient "snaps" and does something horrible, it is our fault.
All the people who are talking about how necessary medication is, and how the condition cannot be managed without medication, and how it is the doctor's fault that the patient was unmedicated, I hereby make you a job offer. You are hired. I will give you a list of all the patients with mental health conditions that need medication in order to function. Your job is to go to their home (or if they are not at that address, you have to track them down and locate them), and give them their medication, and make sure they take it, and do not leave them until they have taken it. If they are agitated or aggressive, that is your problem. You have to deal with it, or call the police, or CATT team, just like we have to. Then, when everyone is medicated and society is safe again, you can come here and talk about medication and how essential it is for mental illness.
Sorry. Unverified rambling opinion source signing off now. I'm off to do something relaxing and enjoyable my day off, like clean the toilet. Or pet the cat.
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