Today I have read reports of the Coronial response to the death of Michaela Mundy, a South Australian student who

had battled depression and sought help from the Child and Adolescent Mental Health Service. She tragically took her own life in July 2012 at the age of 15, after being consistently ignored by those she trusted to support her. This is a tragic end to a case which is not unique. I have been a patient of CAMHS for over a year now, and I truly believe that the experience has left me vastly unhealthier than I was before I entered. The system is not only full of failures, but a systemic incapability to understand the individual needs of patients. I am writing this letter as a survivor of CAMHS in the hope that no other people should suffer like Michaela and myself have. My experience began when I was referred to CAMHS after having an unsatisfactory experience with a private psychiatrist. I had been seeing a psychologist for nearly a year before she deemed my illness too great for her treatment alone, and asked if I would be willing to see a psychiatrist. The private doctor that I visited (who shall remain nameless) told me, in $400 worth of words, that there was nothing wrong with me. Reporting this back to both my psychologist and GP it was seen as a huge underestimation of my problems and I was therefore referred to CAMHS for further help. I do not wish to delve too deeply into the struggles I was facing at that time, but I will say they involved both severe depressive episodes and bursts of psychosis. It was obvious to my doctors and parents that I needed help as soon as I possibly could. I must admit that I am unable to recall the exact dates on which I contacted CAMHS, but I believe that we first approached them for an appointment in December of 2012. I was first seen by a staff psychologist, who was tasked with discovering if I was suitable for treatment by one of the psychiatrists. This was at Southern CAMHS, located at GP Plus in Oaklands Park, and I honestly believe that this was the most pleasant of all of my visits to the service. She asked me many questions about my medical history and my family situation, and at the end of the interview she made it clear that it was vital that I saw a doctor. I and my family were informed that we would receive a letter telling us our appointment time, and that we could expect to be seen within two weeks. At the time I can recall feeling perplexed at how I could be in such a terrible crisis state, and yet left without an appointment for two weeks. It was with complete an utter horror that I was to open the letter sent from CAMHS and see that I had been granted an appointment in September 2013. In a moment of agonising pain at the complete carelessness of CAMHS I found myself standing in my room completely and utterly broken by the news. In a furious phone call to the Southern CAMHS office, my mother was to discover that this had been a typo and, in fact, I was to have an appointment in February, and not in the nine months I had been originally told. I do not know to this day how it was possible that this mistake could have been made, but I can tell you with all honestly that it could have killed me. In the following weeks before my appointment was finally reached my psychological state continued to plummet, and through multiple visits to both my psychologist and GP it was deemed that I needed to receive emergency help. We called CAMHS with a request for an earlier appointment to receive this emergency care and were told by them to go down to the Emergency Room at the Womens and Childrens Hospital. So we travelled from our home in Aberfoyle Park to North Adelaide to sit in the waiting room for four hours. At this point I had not slept for many nights, constantly in fear of the auditory and visual hallucinations which I was experiencing. Sitting in a room full of screaming children, crying babies

and constant movement was as harrowing an experience that anyone with an experience of anxiety and psychosis can have. I was finally pulled into a room with a doctor to be told that I was in the wrong place. Apparently my GP, Psychologist and CAMHS had all given me the incorrect information and there was nothing they could do for me. I became (understandably, I hope) quite aggravated by the news that for a third time I was being let down by the system designed to support me. After being told this, we were asked to wait for another extended period of time while the psychiatrist at CAMHS who had been assigned to me (but had not yet seen me) was contacted to discuss how he would like me to be treated. When they returned they handed me a prescription for a moderately large dose of an anti-psychotic, prescribed by a psychiatrist at CAMHS who had never even spoken to me. I was in no state to refuse this drug, and so began a course of medication which I would continue for six months. It is with bewilderment and anger that I look back on what happened on that day: miscommunication from every party; the unjustifiable prescribing of psychotropic medication; and my being sent back to a home completely unable to deal with my condition. When I was finally seen by my CAMHS prescribed psychiatrist (who shall also remain nameless, through significant amounts of self-control on my part) I was given a diagnosis of Psychotic Depression. We began a course of Fluoxetine (also known as Prozac) and continued my use of Risperidone. I feel it is important for me to state that I am not anti-psychiatry, nor am I anti-medication for the treatment of mental illness. My experiences with both of these however, under the care of CAMHS, were so disillusioning and detrimental that my descriptions of them may appear to be jaded. It is obvious to me that for the near 10 months that I was on fluoxetine, I reported next to zero improvement in my mood and behaviour. My experience with Risperidone was markedly different, however. While having barely a miniscule effect on my psychotic symptoms, it did render me completely incapable of keeping up with the cognitive thought required of me to live the normal life of a Year 12 Student. As I struggled to stay awake, taking this heavy anti-psychotic (also used as sleeping medication) at both morning and night, it became increasingly impossible for me to continue my studies. While I do not blame this medication solely for my eventual leaving of school in May 2013, I believe it played a significant part. It was after a month of taking this course of medication that I was hospitalised for the first time. I spent a number of nights in Boylan Ward. I am unable to tell you much about the experiences I had there, as I can barely remember anything which was happening around me at that point in my life (due to a mixture of medication and disassociation). In the space of a month, I spent two separate periods on Boylan Ward when my psychotic features became too terrifyingly dangerous for me and my family to be managed at home. It was after approximately two months that it was decided that the anti-psychotic medication was clearly not working (after my consistent telling of this fact to my psychiatrist for the entire time). I was then moved to a different medication, Invega, for a far longer period, during which I experienced a marked improvement in my psychotic features. Between June and August of 2013, I had a period of improved mental health, although I continued to suffer with the chronic depression which had been plaguing me for longer than Id been seeing CAMHS. I began to travel with family and found some work which I really enjoyed. I had a short

period where everything seemed to be working. At this point, Id forgotten most of the animosity I had felt towards CAMHS when originally becoming involved with them, and continued my sessions with my psychiatrist. My diagnosis became one of chronic anxiety coupled with psychotic depression. Although I was hesitant in accepting this diagnosis, as I didnt feel panic attacks were a truly significant feature of my personal experience, I was comforted by the reassurance of my doctor that he believed this to be an explanation for my troubles. I was prescribed a further medication, lorazepam, to deal with this anxiety. I was barely able to stand, but I was free of the things that were troubling me. That I was also free of any of the other human emotions that one might hope to experience was inconsequential to my doctor, and thus I understood this as being a side effect I needed to accept as I continued to rebuild my health. Except, as anyone who has felt that crushing period of numbness that comes with depression can tell you, the side effects quickly became all the more horrifying than my illness had ever been. I was incapable of feeling emotion; something which had been bothering me in a milder sense during my treatment for depression but had become exponentially larger during this course of treatment. I saw every motivation I had to continue my job and interact with people slip away, and found myself wishing for death over the thought of leaving my home. Whereas previously I had felt depressed, I now truly began to feel suicidal. I expressed these thoughts to my psychiatrist at a number of sessions, during which he nodded and offered me words of comfort like you can always go to the hospital if you need. I was already distinctly wary of hospital admissions, and so began to make it more explicitly clear that I had plans to hurt myself during sessions with my psychiatrist. A crescendo of self-harm with knives and increased risk-taking behaviours climaxed with a midnight overdose on a small amount of paracetamol. It was not a life-threatening amount, but it was a clear cry-for-help for those around me. I sat for an entire night in Flinders Emergency Room drinking activated charcoal and feeling increasingly sorry for myself, when I finally received word from my psychiatrist. I was to be returned home, and I had to make my appointment in over a weeks time. For the second time, I felt as though CAMHS had left me completely and utterly on my own. My parents were similarly flabbergasted at the lack of even basic levels of care from the South Australian Medical System. When we attended the next appointment, my family raised the idea of admitting me for a longer stay at a facility designed to help me face what was troubling me in a safe environment away from home. We were told that this was completely impossible, and would result in me becoming much unhealthier than if I was at home. Following this meeting, my sessions with my psychiatrist became disturbingly different. I honestly believe that there was some kind of theoretical benefit to how my doctor began to treat me, but whatever the intention was it failed catastrophically. He became aggressive, confrontational and mean-spirited. He brought light to my faults, making me feel as though this was my fault. He demanded that I get a job and continue life as though there was nothing wrong (any mental health sufferer will tell you that this is the kind of comment made by an ignorant friend or family member and is entirely inappropriate coming from a doctor). If this was designed to make me change my ways (as though my illness was my choice) it failed completely, and nearly cost me my life.

My mental state worsened over this period, to the point where I made another trip to Boylan Ward, as I felt I was nearing the end. They took me through the lengthy admitting process, settled me in my room and watched me. This was to last less than 24 hours, as the next morning I was called into a room with a psychiatrist (who happened to be the private psychiatrist I had seen way back in November of the year before and believed me not sick at all) and my parents. There it was explained to me that my diagnosis had been incorrect all along. Now, it was obvious, I had Borderline Personality Disorder. This had been spoken about all the way back during my first visit, they informed me. When I questioned this fact, they revealed that it had only been spoken about between them, and they hadnt felt they needed to let me know about it. Let me be clear: Borderline Personality Disorder is a valid disease, with terrible consequences and viable treatment options; it just does not apply to me. I do not fit the symptoms they ascribed me: volatile mood swings, impulsivity and obsessions have never been a feature of any of my illnesses. In fact the very notion that I had acted impulsively while ending up in hospital, after talking about my plans to harm myself with my doctors repeatedly for months, was fundamentally insulting and fuelled an ever growing fear that the system was not listening to me. I would also question the intentions behind responding to my cries for help with you have a personality disorder. Whether it had been a valid diagnosis or not, the tactless response of writing me off as a disorder was counterproductive and, frankly, cruel. When I argued the point that I didnt feel that the diagnosis was correct, I was cornered in a room and told that my psychologist (someone I had grown to trust over a number of months in therapy) had told them that she supported their diagnosis and would seek to treat it. When I brought this up with her at our next meeting, she told me that she had offered no support to their theory, and was not at all interested in what label they would give me. It was at this point that I began to refer, angrily hyperbolic, to my doctors as sociopaths. When my parents raised the point that perhaps a long term hospital admission may be an option in my case, we were again told that they were completely against this option. They were so against this option, in fact, that they gave us a list of doctors who might be willing to admit me to one of these programs. Can you imagine any other doctor or in fact an entire system which would be unwilling to support a program, but would be willing to tell you how to get to it? The fact that I was sitting in a hospital, only to be told that I was in a greater danger of harming myself than if I had never been a patient, is stunning and unbelievably, objectively wrong. Boylan Ward must be divided in two for you to understand what happens there. On the one side, there are the nurses who work unbelievably hard to keep the whole thing together. They have been exemplary during my entire interaction with them, and I would not fault any part of their work, nor would I doubt their good intentions. On the other hand there is the tired 90s paint job, ironic keep smiling messages on the wall from celebrities, and a system so chronically underfunded that they are completely unable to offer treatment to any of their patients and instead offer an uncomfortable day-care service. Next door to Boylan is the Adolescent Ward, its door decorated with bright colours and its halls brightly lit and friendly. I spent a weekend on Boylan Ward where they forgot to turn on the lights. When conversation (completely unmonitored amongst the patients on the ward) eventually turns to how much better it must be next door, it was often suggested that I harm myself somehow so I get to go there. I do not want to paint Boylan as some kind of twisted ward from a horror story, but that we longingly wished to go to a place reachable only through acts of severe self-harm. Surely this speaks volumes as to the destitute carelessness given off by the atmosphere on Boylan.

It was not long after this visit that I was to see the inside of the Adolescent Ward for myself. Weeks after my previous admission; faced with an ever growing sense of alienation and aggression from my psychiatrist and CAMHS, I took what I thought to be my final step. I swallowed over a hundred pills in the middle of the night, hoping that I wouldnt need to deal with the world (and the system) anymore. It was lucky that I told my parents what I had done, and they rushed me to hospital, where the monitoring and treatment of medical doctors saved my life. I spent a number of days in Adolescent Ward, barely meters from Boylan, and felt the most incredible sense of treatment from the doctors there. The difference was that they treated my physical illness as it was, without any sense of judgement or analysis. They monitored my heart rate, pupil dilation and blood pressure. They smiled when they saw me, and asked me how I was. They treated me how a doctor should treat a patient in crisis. Then I was transferred to Boylan Ward, to experience nearly the exact opposite care. The following week offered no redemption for the pathetic display the South Australian Mental Health System is able to offer young people. I was released feeling no better than I did when I walked in, surrounded by the sentiment well see you when you crash again. My parents desperate search to find a doctor that would be willing to try a different method of treatment was blocked by the fact that out of the ten or so private child psychiatrists in South Australia, NONE were accepting new patients. This broken, painful system is the only option young people in South Australia have. And they are dying because of it. I was released, and started taking back control of my healthcare from the people who had no interest in contributing to it. I stopped taking the anti-psychotic which I was being prescribed as sleeping medication, and demanded an anti-depressant which actually helped me. I am now on, what I believe to be, a healthier combination of medications under which I am feeling better. I no longer go to weekly sessions with the psychiatrist who watched, mouth-agape and inactive, as his patient drove off of a cliff. I trust my therapy with a psychologist who is interested in giving me options, rather than telling me the same options that failed before are the only ones that will work. Im feeling more stable now than I did for the entire period under the primary care of CAMHS. I am seventeen years old. In three months time, I will turn eighteen, and will be able to leave behind the Child and Adolescent Mental Health Service for good. While I will be free of the negligence of the system, I cant help but feel terrified for the number of young people (some as young as ten) who are going to interact with this broken system as long as it stands as it is. Every single day, there are kids sitting in Boylan Ward, surrounded by faded paint and broken furniture which seeks to confirm the feeling that nobody cares about them. Our politicians, healthcare professionals, doctors, parents and patients need to do something about the system we allow our kids to be chewed up by. Michaela Mundy died because the system wouldnt let her into it. I nearly died because the system let me in and then treated me as a statistic to be discarded. As the coroner looks at the reasons why people are rejected by the system, I implore him to look at the fate of those that it accepts. I know that we will look back on the way that people with mental illness are treated now with the same disgust that we look back on the days of lobotomies and exorcisms. I am lucky that I have a supportive family, because without them I would have been on my own for the worst twelve months of my entire life. No, worse. I would have been alone in CAMHS.

Rhys Harrison