Managing patients in the forensic system is pretty interesting. There are some who have been assessed in the corrections system to be mentally unwell (and may have been responsible for actions leading to the incarceration), or some who are in the system for diagnostic clarifications or more assertive management.

It can be frustrating to try and establish some form of rapport with patients who almost always feel that the system is trying to suppress or do injustice to them. Why should I be treated? I'm not mentally unwell...that familiar saying seems to start some of the conversations off. For me, the key is in reassuring them that you're advocating for their interest, and that generally helps a long way. And we are actually doing so, though sometimes we take away their autonomy to decision-making and consent, but generally this is done to assist and help them through recovering from an acute episode of mental unwellness.

Currently there is a young Sudanese gentleman who is in remand for upcoming charges of murder; he stabbed a GP to death in response to a conviction/delusion that the Australian healthcare system has failed to treat him for his physical health. He was diagnosed with Hepatitis C shortly after arriving from Egypt; and now has a complex delusional system about how the various specialists have refrained treatment from him due to certain prejudices/ discrimination. He still is very suspicious about the medical treating team, believing that previous investigation results were fabricated to make it seem like he did not require treatment for his Hepatitis. These ideas preoccupy him everyday, causing him sleep deprivation, high levels of anxiety, also believing that his liver is completely destroyed/damaged due to the delay in his treatment. Though he is on treatment to try to relieve his distress/preoccupation of these physical complaints (which we are also liaising with hepatologist and haematologist), it is just a long process of reassuring him that his current physical health is our priority too, but that he will not die from no treatment in the immediate sense. I feel that he's getting depressed from this perceived injustice and his stay in the hospital, the stigma of mental illness probably doesn't help his current state of mind. I'm trying to regularly see him to address his concerns, with an interpreter, in hope that he is able to perceive that we are truly trying to help him address both his anxiety as well as his physical health.

After a loooong absence of bloggin, I think I deserve to give my hands abit of a work-out.
I'm not saying I don't enjoy bloggin, it's just that I've had a fair bit of things happening lately; with the change in workplace, change in marital status (soon), and also change in attitude towards examinations (this will be transient, trust me)

Well, I've started my stint in forensic psychiatry since the past 3 weeks (went back to M'sia in the middle of those weeks), which has been very interesting. First thing that's different from mainstream psychiatry: you take a much longer time to get into the wards; this is because it is a maximum security facility, so only after you have your iris scanned, your possessions scanned (as in airport security), will you be allowed into or out of the building. Now, this poses a challenge for emergencies; especially medical emergencies, so I guess we'd just have to rely more on the ground staff who are available for that. The second thing is the pace of patient flow. I've only had ONE admission and ONE discharge for the three weeks; and this is in an ACUTE patient setting. If I was still in Dandenong Hospital (acute inpatient ward), I'd have already had at least 15 discharges. Obviously not the ideal (where you only keep patients for about 10 days on average), in the forensic system you will get to know your patients inside-out. And I think I'm starting to get the hang of it, and am enjoying it. The other thing to be mindful of is how controlled the environment is; any slight hint of patients escalating in aggression, they'd be talked down, and if need be, secluded. So I do feel pretty safe here. (most times) And best of all, I get my own office (yay) for the first time since I started my training programme. And I could spend some time bloggin (not emailing, cos they don't allow access to gmail or hotmail etc, darn), and reading the news/current affairs. I'll talk abit about my patients (obviously will de-identify them) , which are a very interesting bunch.

With regards to issue re: marriage, I proposed to Christine in Feb (whilst back for CNY), and I did get a YES. A fair bit of time is now being spent on making arrangements for the actual ceremony, but a lot more thoughts put into the immediate future when Christine does come over to Australia. And, not to forget the financial considerations of the reception; which I'm sure will be pretty significant, but I'm happy to pamper my baby if that's what she'd like. During the trip back (10 days), I proposed, met her family, met her dads' extended family, caught up with my relatives (mostly my dad's side) and friends. So yes, I'm still recovering from the jam-packed schedule from the trip. Let's just say it was a very purposeful trip; enjoying every moment of it, particular the precious time spent with Christine.

Exams? Well, I think it's gonna be a very short phase, but I'm started to fire up for the exams. At present, I'm still trying to rationalise when I should sit for it (this or next year). Regardless, I'm gonna have to start preparing for it, so that if I decide to sit for it end of this year, I'd at least have the courage to face it then. So, I'll keep you guys posted about what happens.

I think I'll stop for now. Will talk in more detail about all the above mentioned later. Cheers.