Psychiatrists learn from the experts: their patients

One of the great myths of what often gets called “mental illness” is that people who have been diagnosed “lack insight”.

The truth is that too many doctors lack the insight to ask – or the time to listen to insights that differ or dissent from the masses of data they have crammed into their busy brains and busy schedules.

Another  great myth is that all psychiatrists must be evil – when in fact very few are. Some are even making the time to listen and to help make space in busy training schedules for trainee psychiatrists so that they too can learn to learn not just from text books but from their patients.

These are interesting times in mental health services and it is always a pleasure to be able to spotlight an initiative within the heart of “the purple empire” that is at least partly about bringing the bureaucracy-dominated practice of psychiatry more in-line with it’s name – psyche – iatry means “soul healing”.

Psychiatry is “in recovery” too, eh?


the star

Providing staff with patient perspective helps foster ‘a well-rounded relationship’

By: Camilla Cornell Special to the Star Published on Wed Jun 11 2014


Photo: Staff psychiatrist Sacha Agrawal (left), with resident, Jake Crookall, calls the benefits of a patient-mentor relationship “transformative.”NICK KOZAK


“Schizophrenic”. “Bipolar”. Clinically depressed. Too often, “people become reduced to that label,” says Kevin Hareguy. “But that’s not who the whole person is. There’s a human being there.”

This is the key message Hareguy delivered to a group of staff members from the Centre for Addiction and Mental Health when he spoke to them earlier this year.

Hareguy is articulate and well-educated, with two BAs, one in philosophy and another in social work. He’s the father of a brand-new baby boy, Oliver. He holds a job as a peer support specialist at Ontario Shores Centre for Mental Health Sciences. And he is eminently qualified to talk to CAMH staff about what they do right, and what they could do better.

After all, Hareguy’s first experience within the walls of CAMH wasn’t as a speaker. He was a patient, hospitalized there on three occasions beginning in 2001. Sometimes he heard voices. Sometimes he was brought in to CAMH because he was acting erratically. Several times he came in under police escort, handcuffed, as is their policy when dealing with the mentally ill.

“It’s very traumatic,” Hareguy recalls. “You feel a bit like a criminal.”

For most of the last five years, Hareguy has been well. And he has been participating in a project that calls on him to share his recovery journey with CAMH staff, offering productive feedback on the care he received at the hospital.

Hareguy is one of a group of 12 former patients who held 44 talks over a year. Their audience: groups of four to six CAMH staff members, including nurses, social workers, occupational therapists, recreational therapists and, on several occasions, doctors.

Hope and connection
“When you work on an in-patient unit, you tend to see people when they’re at their most unwell,” says Dr. Sean Kidd, a clinical psychologist and researcher at CAMH, who initiated the speaker series. “You don’t tend to see them when they’re doing better and getting on with their lives because, of course, you discharge them when they hit a certain point.”

Kidd’s hope in bringing back former patients is twofold: It would provide “living proof that people sometimes do get better,” and offer a patient perspective to staff they don’t often get. The outcome, he hopes, is improved care for patients.

In fact, many staff members are amazed by the feedback about what makes a difference in care.

“It’s the little things,” says Kidd. “Such as a staff member who takes a few minutes to play a game of ping pong with a patient, or talk about the hockey play-offs or crack a joke.” Something that goes beyond, ‘Did you take your medication?’ or ‘Have you thought about suicide?’”

During one of his hospital stays, Hareguy recalls a staff member bubbling over with anticipation about her upcoming wedding.

“I would always ask her, ‘How are things going with the plans?’” he recalls. “And she would tell me. She let me in on a part of her life and that was important to me.”

That may sound touchy-feely, says Kidd, but “underneath this is some pretty serious business.” So much of the stuff that feeds into clinical decision-making around mental health comes out of a conversation with the patient, he points out. “It’s not like getting an MRI or a blood test done, which is more objective.”

Having a well-rounded relationship with a patient “where they feel a little more trust and engagement has a lot of potential to feed into better assessment and better clinical decision-making,” says Kidd. “That’s the underlying agenda.”

Mentors with “lived experience”
Providing staff with a patient perspective to further good care is a concept dear to CAMH psychiatrist Dr. Sacha Agrawal’s heart. He recently launched a mentoring program where fourth-year psychiatry residents meet with people with “lived experience” of mental illness for an hour monthly for six months.

The goal? For the residents to get a better understanding of the lives and needs of the people they’re treating.
Agrawal knows the benefits of such a mentor relationship. While still a student at Yale University, he set up a series of meetings with Maria Edwards, a peer support worker who’d worked with hundreds of clients and been in and out of the hospital system herself.

It turned out to be “really, really informative for me,” he says. “I would even say it was transformative.”
For one thing, Agrawal admits he hadn’t clearly understood what he calls “the insidious us-and-them dichotomy” between the mentally ill and those supposed to be helping them.

“Because of those boundaries,” he says, “I think there are a lot of ways people who use our services feel looked down on and alienated.”

One example: Doctors often refer to patients as “non-compliant” when they refuse to accept treatment recommendations, he points out.

“In my work that is often seen as a problem with the person’s thinking — they’re not able to see the need for treatment.” But Edwards helped him understand that the reasons are much more complicated, sometimes stemming from past trauma, or a fear “of being judged or criticized or labelled, or involuntarily confined, or incarcerated.”

Edwards even helped him get in touch with some of his own faulty thinking.

“The first time we were supposed to meet, we had a mix-up about locations,” Agrawal explains. “The two of us were sitting in different places waiting for each other.” Rather than thinking there must have been a miscommunication, “I was thinking, ‘This isn’t going to work out. She’s probably not going to be on time. Does this peer support worker really have anything to add to my education?’”

Only after he came to know Edwards — a woman “who has lived through it all and yet she arrived on time, and was articulate and powerful and has done amazing work” — did he become aware of his biases and how they could potentially impact his work.

Insights like those have an impact on how psychiatrists practice, says Dr. Jake Crookall, one of the residents currently participating in the mentoring program. He admits his initial interactions with patients tended to focus on such things as their symptoms, the drugs they’re taking and their side effects.

Getting to know his mentor has helped him see that those things may not be of prime importance to the people he treats.

“Sometimes they’re more concerned with getting a job, or housing,” he says. In order to help people, it’s important to connect with their goals.

Now, he says, “the first questions I’ll ask are: ‘What are your goals? How can I help you?’

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5 Responses to Psychiatrists learn from the experts: their patients

  1. Thanks for posting this! It fits perfectly with a lecture I’m giving next month!


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