Treating the Psychotic !

It must be the ultimate horror when a 38year old schizophrenic man stabs his five year old son to death in the belief that the child is the devil, but this is compounded when it is learned that his family sought hospital treatment for him just days before and were turned away because " no bed was available  ".

Mental health is like an unexploded bomb ticking away in our health system.  A vast number of people with psychiatric problems live safely in the community because their illness is controlled with medication. So often, a simple family argument results in the patient discontinuing his or her medication - and quickly running out of control.   In many cases that is a time of acute danger to anyone associated with someone suffering this form of mental instability.

Sometimes such an event is terminated by a confrontation with the police.  Recently, a young woman brandishing a knife was shot dead when she appeared to threaten attending officers.  We live in an age of terrorism and police are entitled to defend themselves and they have a sworn duty to protect other members of the public. That decision to open fire must be decided by the officers appraisal of the situation.

The man who stabbed his son to death has since been found not guilty of murder by a Supreme court judge because he was in a psychotic episode.  As a consequence, he will be detained in a medical facility until such time as is required for the doctors to pronounce that he no longer poses a threat to society. It is possible that in a short time he may be again walking the streets of Sydney on day release.

We always find a bed for a person suffering a mental illness when they appear before a court to answer for action they took under psychosis.  Quite often the appropriate medication will quickly  have the required effect and that person is judged as ready to return to society, but that stability is only consistent with the medication being continued. No psychiatrist is able to predict that with any degree of accuracy.

Our emergency system is failing badly if we are turning away psychiatric patients on the grounds that no beds are available.   They should be detained until they receive appropriate examination and the danger evaluated.  In the case of the five year old brutally stabbed to death by his father, the medical establishment simply walked away from confrontation and threw the problem back into the hands of this mans parents.   The outcome was a dead child.

Perhaps this is the time to combine the care of the dangerously delusional with the facilities of the police.  If a hospital emergency department lacks the ability to restrain a person having a psychotic episode then perhaps a police cell may be the better safety option for several hours.

The death of this innocent five year old illustrates that our response to  psychotic episodes is not up to scratch and needs new emergency protocols to be put in place.