We meet Hannah a few weeks after she begins working as a registrar in the Mental Health Services’ Acute Unit at Menzies Hospital.

“Acute psychiatry is the emergency medicine of mental health: for the stuff nobody saw coming. Until someone close to them becomes paranoid or overdoses or begins cutting themselves.”

We follow Hannah as she finds her feet in this role while working towards her goal of being accepted into the psychiatry training program. Along the way, we’re introduced to Hannah’s colleagues and patients. It’s confronting meeting people experiencing some of the worst moments of their lives and throughout this book you’ll witness what mental health emergencies can look like.

I got off on the wrong foot with Hannah. Her appearing to casually ‘diagnose’ a colleague she barely knows and her blind spot about how beneficial therapy could be for her irked me.

“As for getting therapy myself, it’s not at the top of my to do list right now.”

Her ability to put off getting therapy surprised me too. The people I know who work as psychologists and social workers all have regular supervision appointments. I expected to be attending the psychiatry equivalent with Hannah, even if she didn’t go to therapy herself, but if this was part of her life she didn’t invite me along.

Hannah slowly grew on me as I made my way through the book but my own bias prevented me from warming to her much. I’ve noticed in my own life that people in helping professions who are hesitant to work on themselves are less likely to be able to sit alongside me as I work on myself. Hannah’s reluctance to do so, while I knew there’d be a reason behind this, meant that I never really trusted her.

It didn’t help that sometimes her judgements about patients and lack of sensitivity infuriated me.

‘How can she bear to be so pathetic?’

This is challenged by a coworker. Thank you, Jon.

Connecting with a main character isn’t essential, though. I’ve liked plenty of books where I didn’t and liking Hannah isn’t necessary to enjoy this book. There are so many other people to meet, both patients and staff.

There were some, like Nash and his clear disregard for the value of social work, that I wanted to steer clear of. Then there were others I wanted to spend all of the book with.

Carey’s insight made me want to get to know them better and I loved Elena’s ability to think and work outside the box. I wanted to go back in time and advocate for Chloe and Brianna.

This book provides a rare glimpse at what working in this field is like, from an insider’s perspective. You feel the pressure of making the right call because the wrong one could result in someone’s death. You witness the struggle to free up beds to work within the parameters of a healthcare system that’s flawed at best. You see the power struggles amongst the staff and are wearied by the politics.

I found it interesting that by beginning the chapters with just a snippet of conversation or a scenario about someone we don’t know yet, it invites you to make a judgement call on what diagnosis the patient will be given, and indeed who the patient will be. It’s easy to start seeing people as diagnoses, not people, like when Nash talks about patients as PD’s (meaning personality disorders), stripping them of their humanity.

I don’t have a problem per se with diagnoses or with appropriate mental health treatment. My bugbear is when peoples’ normal and expected responses to trauma are given a diagnosis that’s then used to discredit their character and reliability. This didn’t play out as much as I expected here but I still cringed whenever a personality disorder was diagnosed.

I kept thinking that this is what a mental health spinoff of 24 Hours in A&E might look like. This book provided mini case studies that ran the gamut of mental health emergencies.

I can see this working well as the first in a series. I’d be interested in watching Hannah grow in both her personal and professional life over time.

Content warnings are included on my blog.

Thank you so much to NetGalley and Hachette Australia for the opportunity to read this book.

“Our patients’ problems are so complex, our treatments so crude, ourselves so human.”

The Glass House is the third novel by husband and wife writing team, Anne Buist and Graeme Simsion. After three months as registrar on the Acute Psychiatric ward of the Menzies Hospital in Melbourne, twenty-seven-year-old Hannah Wright is hoping she will be able to mitigate the effects of the incident that led Professor Liron Gordon to reject her entry into the hospital’s psychiatric training program.

She has six months to impress, while treating the wide variety of admissions: pregnancy psychosis, suicide attempts, manic depressive, religious delusions, schizophrenic, histrionic personality disorder, anorexia nervosa, and PTSD; some are heart-breaking, some, like the manic, comical, although a colleague notes ”On the surface, he’s entertaining. Underneath, he’s battling a life-threatening illness”, one or two, professionally satisfying, and a few are sobering, serving as a warning: “All of us are at risk of mental illness. It can happen to any of us, out of the blue.”

Against a (sometimes distracting) background of power plays between her boss and the hospital’s new Director of Mental Health, well-meaning interventions by Child Protection, and patients’ family members with their own agenda, Hannah does manage to save some lives with a combination of training, past experience, luck, and intuition.

Well aware that she’s often seeing patients at a low ebb in their lives, Hannah tries to imagine them at their best, until another registrar points out that putting herself in their shoes, as well as assessing her patients more holistically, might prove more helpful or effective. And, of course, it’s a team effort that involves consultant psychiatrists, trainees, interns, nurses, psychologists, social workers, occupational therapists and the occasional student.

Hannah soon sees the value of the psych nurses’ input: “Increasingly, I’m trusting his take, and that of the other experienced nurses, on my patients. They spend more time with them than I do; I seem always to be on the phone to relatives, pathology or other hospitals and doctors. Not to mention doing paperwork.” And the time trap that paperwork is: “‘Time spent on accountability,’ Nash says, ‘is time spent away from patients. Someone should be accountable for that.’”

Discussion with her fellow registrars is always valuable for the sake of perspective. With the anorexia case, they acknowledge the associated stigma: “Would we say the same if it was sixteen admissions for asthma?’ A friend from school spent eighteen months in hospital after a motorcycle accident. We do think differently about mental illness.” More generally, they recognise the need do their best and then, if they are to survive, to detach, because “our patients will do what they will, we’re only a small factor in it.” Hannah examines the reasons she opted for this profession and certain incidents lead her to doubt her choice.

The cases that Buist gives her protagonist are intriguing and it becomes apparent that often there is no simple answer, that a mix of therapies might get the best result, or that it may require the right intervention at the right time; that the best result might not be wholly satisfactory and likely far from perfect.

Buist gives some of her characters insightful observations: “It’s tough to have your mistakes pointed out in public, and, god knows, we all make them. Review and criticism is part of every job. It can’t happen if there’s a culture of fear and humiliation – or schadenfreude”. Also “There’s a lot of pressure to treat what’s seen as urgent, and tangible. Obstetrics, blindness, drug abuse, plain life expectancy . . . plenty of work to do. Psychiatry’s seen as a luxury, as the medicine you do after everything else… Yet depression is one of the leading killers.”

This is also a novel that reminds us that those practitioners charged with the treatment of the ill and vulnerable are themselves human, and despite thorough training and expertise, may be plagued by very human flaws and failings, and their perceptions, attitudes and reactions to their patients’ presenting symptoms may be coloured by their own history.

Most chapters are prefaced by a description of the episode that results in the admission of a patient into the Acute Psych ward. The banter between the characters is often entertaining, and some of the dialogue is laugh-out-loud, if blackly, funny. Of course, Buist’s background gives each aspect of the story a ring of authenticity, so this portrayal of mental illness and its treatment, and of the mental-health system, is wholly credible, but also topical, laced with humour and quite thought-provoking. Recommended for anyone who thinks and feels.
This unbiased review is from an uncorrected proof copy provided by NetGalley and Hachette Australia.