Forensic Psychiatry 

Day 1 of psychiatry. The first day of rotations are always really lame because it’s a new place with new people and there’s the awkward tour where you’re trying to remember everything you see but all the hallways look the same and you gotta introduce yourself 15 times to everyone you walk past, and and sigh.

Plus on the first day there’s never much to do. You just pretend to do some study or look mildly interested while thinking about the 6 weeks to come and the daunting assignments/assessments that need completing.

Today was no different in that respect. But this placement is very interesting for me. As the title suggests, I’ve been placed in forensic psychiatry. Where mental health meets the law. I’m in a relatively small practice known as Mason clinic in Auckland. It’s an extremely high security clinic for offenders with mental illnesses.

Apparently this is a scary place. When you google Mason clinic, some of the phrases that come up include “where the mentally insane killers are protected in the most secure mental clinic in Auckland” and that it is “home to some of the country’s most dangerous offenders”.

During orientation, the first thing the students received were these:

The rectangular thing on the left is a “personal alarm”. It is essentially a distress call that will have staff running your way in “about 10 seconds” in case you’re being attacked or held hostage or something. In addition, all hallways have reflective glass near doorways so you may see if someone is tracking behind you. Every door is swipe and fingerprint protected. I was also given a heavy iron key that opens certain doors in the high security areas. Oh and no lanyards as they pose a significant safety risk in case someone wanted to strangle you. No messing about in this place.

I knew I was placed in Mason clinic. The idea didn’t scare me much. But some of my colleagues were clearly spooked and were discussing ways to hide their ID cards and thinking up fake names to give to patients during history taking sessions. Oh and we’re also not allowed to carry out patient interviews alone. Always have a staff member present for your own safety.

Psychiatry has such a stigma. It’s kind of borderline funny for me. We always having teaching that tells us to position ourselves in the room with a psychiatry patient such that we are close to the door and can run away if any problems arise. Yes, I know,  safety first and all that but still. From the patient’s point of view, won’t that make them feel suspicious and as though we’re scared of them? Honestly these bulky personal alarms. I’m worried the patients will see them and think that we find them a significant threat. This is the 21st century people! Can’t we get smaller, more discreet alarms? How am I supposed to build rapport with a patient if I’m walking in going “yeah watch yourself pal, I’ve got an alarm and I’m not afraid to use it”. 

It can’t be easy having a mental illness as it is. But then with the added feeling that you’re a danger to others? That kind of thing might distress some people I think. 

But hey. They’ve been using these things for ages, so I might be the only one who thinks it might be weird for patients. I also wonder if they’ve ever had issues with patients with paranoid schizophrenia thinking that we’re using these personal alarms to spy on them or something. 

Okay now I’m just pushing it.

Oh and someone’s personal alarm went off today. It was a false alarm, but we’re supposed to treat every alarm call as genuine and go running. I’m so scared I’m going to accidentally set mine off. Eugh. They’re just too big and bulky. 

Well that’s day 1. I think psychiatry is going to be really challenging for me. We’ve had next to no teaching at all on this subject in the last 4 years. Except yesterday when a couple of psychiatrists attempted to conduct a crash course in psychiatry. Which was extremely overwhelming. Did you know that there’s a DSM 5 now?! These DSM people need to stop and take a breather. The criteria keeps getting thicker and thicker. And to be honest I feel like it’s including more and more normal people characteristics to diagnose a person with mental illness. 

It makes me question my own sanity. Sigh. This should be interesting. 

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