In psychiatry, as in other branches of medicine, there are various branches and levels of specialty. While a GP might treat depression or anxiety or even bipolar disorder, many patients with psychiatric disorders will either have a consult with a psychiatrist or be treated by one regularly. This ensures that the patient has someone monitoring their condition and the medications that they are on, their blood serum levels of certain medications, and checking to see if there are any negative things happening to the kidney and liver, etc. from the medications.
If the patient gets pregnant, they are shifted from their psychiatrist (if they have one) to a perinatal psychiatrist, because most psychiatrists are uncomfortable treating a woman while pregnant, so a new layer of specialist is required for the duration of the pregnancy and often for a year or two postpartum (a fragile time when things like postpartum depression can occur and while the woman might be breast feeding and calls need to be made over whether or not she can on certain medications). Unfortunately, in most areas of Canada, specialists are in short supply and "special" specialists are in even shorter supply, leading to long wait times and difficulties for a patient to get an appointment or consult with a "special" specialist like a perinatal psychiatrist.
In early May of this year, my psychiatrist told me that he would not treat me while I was undergoing IVF. He said that he lacked familiarity with the hormones used in the process and their potential impact on my bipolar disorder/anxiety disorder to feel comfortable treating me. He said that I would have to be treated by a perinatal psychiatrist. I asked him to refer me to one (in Victoria the office is out at Victoria General Hospital and has a couple of perinatal psychiatrists). His office told me that he would not refer me when I called, so I went to my GP and asked him to refer me. My GP gladly did this (it turned out that my psychiatrist also sent a referral letter and that his office had somehow failed to communicate this to me).
Then I waited. I started to get concerned and called the perinatal psychiatry office. I was told that there were no appointments available until late summer at the earliest (I was calling in early May). They booked me an appointment in the late summer.
Then I got pregnant before my first cycle of IVF was set to commence. I called up the perinatal psychiatry office right away (as instructed by my psychiatrist and the Victoria Fertility Clinic) and asked if there was any way that I could get in earlier to see the perinatal psychiatrist who I had been referred to, since I was pregnant and my dose of lithium would have to be adjusted with my growing weight and blood volume (I did not want to deregulate, have an episode, and put the baby at risk or worse yet, be on a level of lithium carbonate that would be toxic to the growing baby). The perinatal psychiatrist's office told me the perinatal psychiatrist was absolutely swamped. I asked what I was supposed to do if I my psychiatrist couldn't or wouldn't treat me and the perinatal psychiatrist couldn't fit me it? Ie. who would provide me with the required medical care (someone has to order blood tests, interpret them, and then give me prescriptions for my medication)? The office eventually said that I could come into the office in June. I was concerned that I'd still have to wait several weeks, but relieved that at least it wouldn't be the end of the summer. You shouldn't have to beg for basic medical care and I was disgusted with how much I had had to push to get even that appointment (what if I was less proactive or less able because I wasn't stable?).
Then they cancelled this June appointment.
I miscarried June 15, 2016. I didn't tell the perinatal psychiatrist's office that I miscarried though, because I knew that I'd be booking an IVF cycle again and my psychiatrist wouldn't treat me during it, so I'd need the perinatal psychiatrist very soon. I hoped that I would get in to see the perinatal psychiatrist before my first IVF cycle, so that she might warn me what to look out for with the IVF hormones, my condition, and the medication that I'm currently on.
The perinatal psychiatrist's office booked me in for an appointment near to the end of June this time. Then they called and cancelled again.
They then rebooked me for September. Then on the day of my appointment, they called to cancel again. They told me that the perinatal psychiatrist was off on leave and that when she was back (in 2 weeks) I would be at the top of the list to see her. They would call me to book me in in two weeks.
Well, it's now October and no one from the perinatal psychiatrist's office has called me. If I was actually still pregnant (and they don't know that I miscarried in mid June, so for their purposes I am), I would be five months pregnant and still would not have had an appointment with a perinatal psychiatrist (so, more than halfway through a pregnancy without ever having been treated by the specialist who is supposed to treat you for the duration of your pregnancy).
I find this level of failure of care in our medical system abhorrent. Is it because I have a mental disorder that it's acceptable that I'm not provided with a basic level of required medical care, that no one will treat me at all? Or is this just our medical system in general? One only has to look at a newspaper, online, or listen to people's stories to know that medical care in Canada leaves something to be desired. In Canada, about 50 cents on every tax dollar goes towards our medical system (and in BC we pay MSP fees every month on top of this too), yet our medical system is piss poor.
When I questioned the perinatal psychiatrist's office earlier in the year about what I was supposed to do (in the mean time) since my psychiatrist said he couldn't/wouldn't treat me and the perinatal psychiatrist couldn't fit me in, the medical office assistant suggested that until I was able to get in (which seems to be never in Victoria), my GP or my psychiatrist would just have to be instructed by letters from the perinatal psychiatrist over what my dose of psychotropic drugs should be, etc. Really!? If you told a cancer patient that they couldn't see an oncologist and that their GP would just be tinkering around with the radiation and drugs and doing their best to try to treat their cancer (when they had never been trained in oncology and had only read bits and pieces about it), it would not fly (and like cancer, mental disorders and illnesses have very high rates of death, including from suicide in the case of disorders like bipolar disorder).
I have a feeling that a lot of this intolerable situation with regard to treatment of mental disorders stems from the fact that it is still not acceptable to have a mental disorder or illness in our society (or at least not to admit that you have a mental disorder and seek help). It is shameful, the system is underfunded, these disorders are feared, shunned, seen as weak or immoral, and they are not treated with the level of care that other illnesses are (one only need look at the psychiatric emergency triage in Victoria- PES- where most patients are not given a bed while they wait half a week to two weeks to get into the hospital, but instead are expected to sleep sitting up in armchairs. That would never happen to a cancer patient or someone with a broken arm).
I asked my psychiatrist in June what I was supposed to do to get care if things started to go wrong. He said that I could always just go to the hospital if I suffered from a relapse. Oh great, so I could go to PES and sleep sitting up in an armchair for half a week to two weeks before getting into the actual mood disorders unit of the hospital? And I could be around psychotic strangers who could lash out and injure me or my baby (and I've been hospitalized there more than once, so I can tell you that people do have psychotic meltdowns from time to time where they must be restrained by security and the nurses, drugged, and dragged off to a restraint room- it is not a relaxing or healing environment to be in for anyone). He told me that he could always get me on the waiting list for the actual hospital. For those who don't know, this can take up to half a year in Victoria, although he told me it might only take a few weeks (great, so if I'm suicidal, I can just wait around three weeks for treatment?).
Yes, I could call the perinatal psychiatrist's office yet again, but I'm so overwhelmed and overwrought with the IVF process, that I just can't do it right now. Maybe I'll do it tomorrow, just to check that they didn't make me an appointment and then forget to call me to tell me that I have an appointment (wouldn't surprise me given that they cancel appointments at the last minute). But maybe I won't call. Why bother, when I know that they won't have an appointment for me and if they do, they'll just cancel the appointment at the last minute again.
I've been waiting five months now for an appointment with a perinatal psychiatrist and it seems I'll be waiting a lot longer. It appears that in this medical system, it's every person for themselves and only a very few get an acceptable level of care (especially given the amount we all pay for this medical system). It's only the squeaky wheel that gets the grease and I can't imagine how many people are falling through the cracks.
P.S. I called the perinatal psychiatry
office to check if I had somehow missed being told about an appointment (I
didn't want to miss it and then have to wait several more months). The
assistant said that the psychiatrist was back now and then she asked if I had a
referral (so I guess that if I hadn't called I would not have been given an
appointment like I had previously been promised at the beginning of September
when my last appointment was cancelled). I told her that my referral was sent
in five months ago and that I had been waiting to see the psychiatrist ever
since. She put me on hold and went searching for my referral, which she found.
She said that she could get me in next week for an appointment. She apologized
for the long wait, but said that they've been short of doctors for months
(don't they have locums?). I only hope that this fourth appointment time will
not be cancelled like the other three have been so far.
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