How ice addiction is having massive impact on mental health of Coast addicts
Paranoia, hallucinations, extreme aggression - the symptoms of ice psychosis. But it can get a lot worse from there, reveals a Gold Coast psychiatrist dealing with the fallout of the drugs epidemic
News
Don't miss out on the headlines from News. Followed categories will be added to My News.
PARANOIA, hallucinations, extreme aggression … the diagnosis is simple: another case of ice psychosis at Gold Coast University Hospital.
At least, it’s simple the first time.
Over a matter of months, the diagnosis changes as the drug takes hold of the patient’s brain, and doctors are helpless as that temporary high turns into an irreversible low. Continued abuse twists the brain, creating a serious and permanent mental illness that’s all but indistinguishable from schizophrenia.
GCUH director of inpatient mental health and consultant psychiatrist Dr Shail Bethi estimates a third of patients diagnosed with drug-induced psychosis will go on to develop a pervasive psychotic disorder.
It scares him.
“The first time you see them you think it’s straightforward – they’ve taken amphetamines, they’ve become psychotic … it’s drug-induced psychosis,” he says.
“But if this behaviour continues over a period of time, they develop this pervasive serious mental illness. These drugs are known to create that damage to the brain.
“Brain damage caused by methamphetamines is virtually indistinguishable from schizophrenia. It’s frightening.
“This ice epidemic is just so new to me. When I worked in the UK, meth use was very, very rare.
“Over here, this is a whole new kettle of fish.
“This meth culture is, my God, so rampant and the Gold Coast is so particularly vulnerable. My colleagues say this has been going on for years and we don’t see any signs of it slowing down.”
Across Gold Coast Health – including the Alcohol and Other Drugs Service, emergency department and community mental health – there were more than 18,900 drug and alcohol patient encounters in the 2017/18 financial year.
From July to October 2018 alone, the encounters were up 7 per cent on the same period the previous year.
SUBSCRIBE TO THE GOLD COAST BULLETIN FOR JUST $5 A MONTH FOR THE FIRST THREE MONTHS
Dr Bethi says alcohol remains the single biggest issue for patients with a mental illness.
“The age of patients that we see is getting lower and lower. I’m not talking about social drinking but actual dependence,” he says.
“People are getting very clever at using one drug for one feeling and then medicating back to another feeling. They try to control their highs and lows but inevitably they end up here. Drugs never fix the underlying problem.
“Even once they’re on the ward, we catch people still using. Accessibility is just too easy.
“We see 12 year olds using cannabis and these young minds are just changed forever.
“But we continue to do our best. The first part of our job is to manage the distress or the psychosis. Longer term we try to help them abstain from drugs. It’s always a multi-pronged approach.
“It’s very difficult to separate too which comes first, substance abuse or mental illness. It’s a high rate of comorbidity.
“It’s a tough job but we always believe in hope.”
Dr Bethi’s bleeding heart is perhaps the perfect antidote for fractured minds.
As a young doctor in training, he says he was never drawn to psychiatry. Instead, he was focused on cardiology.
He can laugh about it now.
“I grew up in India and the mentally ill were never near us. I grew up with misconceptions and media stereotypes instead. I’d heard stories and seen how government psychiatric hospitals were. I wasn’t interested. I didn’t even do an elective in psychiatry,” he says.
“Later I moved to the UK and one of my good friends was passionate about psychiatry and I asked him just what it was that made it so fascinating.
“I ended up taking months off so that I could follow him around in his training. What I saw changed me. Once I saw how psychiatry is practised in the western world, it just transformed my view.
“What started as a shock two-month unpaid elective turned into something so different. It was very serendipitous.”
READ MORE
Worst streets for drugs on the Gold Coast
Rehab clinics struggle to deal with ice epidemic
Perhaps never more so than when Dr Bethi’s career path led him to the Gold Coast.
Despite the scourge of drugs in our city, he says he fell instantly in love with his new hometown.
“I had never even visited Australia before and our plane landed at Coolangatta at night. We went straight to our apartment and to sleep.
“When we woke up the next morning, I’ll never forget … I opened the curtains and there was this glorious ocean and the Broadwater.
“I turned to my family and said, ‘We’re actually in paradise’. We all changed into our swimsuits and ran to the water. It was love at first sight.”
However, Dr Bethi says the greatest part of his job is witnessing the courage of his patients.
And although he can dispense prescriptions and medication, he says his true surgeon’s scalpel is simply talking.
“My ability to communicate is how I can help people,” he says.
“It is so rewarding to be a part of my patients’ journey. It takes so much bravery for someone to open up to you and talk about their deep dark fears and private, personal aspects.
“I would never want to do that. But they do it … and the confidence they have in me to help them is overwhelming. You don’t find that kind of trust anywhere else.
“It means so much to me. I just have to do something to help them, to relieve their suffering.
All doctors have compassion but I believe the level at which psychiatrists must have that makes it a very special specialty.
“The more I do, the more rewarding it is. Not that I’ve managed to relieve everyone’s suffering, but I’m always trying.”
Which is why Dr Bethi worries about the seemingly unstoppable trend towards ice addiction that is helping to fill his beds faster than they can be emptied.
With 120 mental health beds spread across GCUH and Robina Hospital, there were more than 2700 mental health inpatient admissions during the 2017/18 financial year.
Bed pressure is a problem for most hospitals but the Gold Coast suffers a particularly tight squeeze. GCUH’s emergency department is Australia’s busiest, with hundreds of presentations per day, many of whom are referred to Dr Bethi’s unit.
“We have community teams who work outreach with some of our patients and they can bypass the ED and bring them straight here. Waiting in ED can be just too distressing for them,” he says.
“There is almost always pressure for space for our 120 beds.
“There is such high demand on this hospital. We have a very high occupancy rate. There’s always ebb and flow but right now we’re in the midst of a very sustained pressure on our mental health beds.
“If someone needs a bed and we don’t have one open, it’s my job to find that space.
“That’s the creative part of the job. We have acute beds, subacute, acute young adults beds for 18-25s who have their own unique needs, beds for over-65s, mental rehab beds, the lavender ward for mothers and a children’s ward as well.
“The ideal service would be to embrace everyone and provide indefinite high quality care, but the line must be drawn somewhere. It’s tough.”
However, Dr Bethi says overall he feels excited about the direction in which the hospital in general and his ward specifically are headed.
He says GCUH is in the midst of a cultural change, with a renewed emphasis on compassion and care.
He says his department specifically is working towards a vision of zero suicides.
“Our director is behind this goal – it’s fantastic. In the four years I have been here there have never been any suicides on the ward, but it is always a risk when patients are discharged to their homes,” he says.
“Of course, having this goal does create some anxiety for those of us working in the system to get it right, but it takes a community effort. It’s not just down to individuals but the organisation.
“It’s about building basic standards of care. If someone walks into the ED with suicidal ideation, I should be confident of the care that we can offer, as well as the support when that person returns home. Confidence and community engagement is key.
“The hospital in general has also adopted as its motto ‘always care’. Our emphasis is on the person. In mental health, we’ve added ‘always there’ as well. That’s what we want our patients to know.
“Sometimes we have patients who present 10 or 12 times. It’s important they know we are here. And for us, it’s never a case of ‘not again’ but ‘what can we do differently this time’.
“No system is perfect but if you start with always care and always there, that’s huge.
“When I look at the cultural change happening, I get excited.”
Dr Bethi says staff are also transforming the way they treat risk on the ward.
He says although the hospital’s mental health unit does not house a ‘locked’ ward, there are patients in the psychiatric intensive care unit who can pose a danger to themselves and staff.
“There is always danger on the ward but the way you manage the risk is more important. “There are times when security personnel must be called but we are working very hard to minimise these occasions.
“We don’t have a high security mental health ward on the Gold Coast. There is only one in the state and that’s in Brisbane. But we do have a medium secure service. We’ve actually renamed it to the secure mental health rehab unit. We want the focus to be not on security but rehabilitation.
“These are not criminals but people who are ill.”
Again, it’s a simple diagnosis.
But it’s one that requires not just the mind, but the heart.
First look: Coast’s new elite sports training facility unveiled
The Gold Coast will be rebranded as a hub geared for high performance sport, with the first images of a planned elite sports training centre unveiled. FIND OUT MORE
Burleigh ‘cannot become a southern Surfers Paradise’
Labor and the LNP have been warned against snap decisions to make Burleigh a safe night precinct, with fears it would open the door into transforming it into a nightclub hub.