The Oasis

Book 0: Menzies Mental Health

by Anne Buist, Graeme Simsion

Genres: General Fiction; Literary Fiction; Humorous gen fiction

Synopsis

By the bestselling authors of The Glass House, Anne Buist & Graeme Simsion, comes the second novel in the groundbreaking Menzies Mental Health series

Trainee psychiatrist Doctor Hannah Wright has only just got her head above water in the acute psychiatric ward at Menzies Hospital when she's thrown into the deep end of the outpatient clinic. Keen to develop her skills in talking therapies, she finds herself up against a boss who's focused on medication and a senior colleague with a score to settle.

Hannah's fellow first-years face problems of their own: on-and-off flame Alex is being bullied, Ndidi's marriage is in trouble, Jon feels isolated and Carey is concerned their autism will be a career barrier.

While Hannah comes under pressure to seek therapy herself to confront a traumatic past, her patients' health issues range from OCD to ice addiction, childhood abuse to the mental impact of ageing, and from bad parenting to bad genes. They all come to the Oasis.

Written with great humanity and humour, Australian psychiatrist Anne Buist and internationally bestselling author Graeme Simsion (The Rosie Project) welcome us into the world of mental health with compassion and insight.

Praise for The Glass House

'A masterfully told, character-driven novel that will have you laughing and crying in equal measures' THE AUSTRALIAN

'A deeply empathetic, humanising portrait of a mental health facility, and the souls that pass through it' THE AUSTRALIAN WOMEN'S WEEKLY

'Stunning . . . So timely' DAILY TELEGRAPH

'Absorbing' INSTYLE AUSTRALIA

'A darn good read' LIVING ARTS CANBERRA

'Brings alive the frontline of mental health care' PROFESSOR PATRICK MCGORRY AO, AUSTRALIAN OF THE YEAR 2010

'Overflows with compassion, insight and humour' MEREDITH JAFFÉ

'Gripping, rich and insightful' ARIANE BEESTON, author of Because I'm Not Myself, You See

'Anne Buist skilfully writes from her own experiences and co-author Graeme Simsion adds his inimitable Rosie Project style. An honest, sensitive look into mental health care in Australia' PROFESSOR JAYASHRI KULKARNI AM, Psychiatrist, Monash University

Release date: February 26, 2025

Publisher: Hachette Australia

Print pages: 352

Sample

The guy getting out of the battered hatchback has tried to strike a balance between fitting in and hiding his identity. His orange safety vest and the extension ladder protruding from the back of the vehicle – red briefs tied to the last rung – give a fair impression of a tradie or cleaner. The hoodie, head torch and the bag of rope he’s unpacking suggest a burglar, or someone breaking out a prisoner. The latter is pretty much what he’s aiming to do.

Inside the Menzies Mental Health Service’s Extended Care Unit, dance-music producer and inpatient DJ Voices is pulling the top off a piano stool. It arrived a few days ago, along with the new keyboard that she’d been permitted to accept as a gift.

In the stool’s storage cavity, beneath a false bottom, are two small audio players packed in bubble wrap. DJ’s accomplice – the guy outside with the ladder and rope – visited earlier in the week and they scoped out where to put them: a fist-sized hole in the wall of the common room, and a gap at the back of the bench in the tearoom.

DJ is thirty-two with green hair, dressed more neatly than the other patients in jeans and long-sleeved t-shirt: street clothes for the street outside. She’s significantly overweight – a side effect of the antipsychotics. They also have a sedating effect, but right now the adrenaline is cutting through, giving her clarity, as it does when she performs.

Her accomplice is wired too, but he’s struggling to get the ladder extended and propped against the courtyard wall. And now, the tricky part: the other side, where DJ Voices will have to climb up. No way could he get a second ladder over. And no way could she pull herself up a rope. His solution is a rope ladder, anchored to the hatchback’s bumper.

After three trips up the regular ladder, he gets the length of the securing rope right. A helicopter might have been simpler.

DJ has hit play on the audio units and dropped them into place, and is waiting in the common room for the fun to begin. It doesn’t take long. ‘Help, let me out. I’m trapped! I can’t breathe!’

Nice clean sound and surprisingly loud. She can barely suppress her laughter. Let them be freaked out by voices for a change. And they are.

Commotion, then a code yellow over the PA system. People arriving. She waits for the confusion to build, then heads for the courtyard … only to find that’s where the staff are shooing her fellow inmates, clearing the building. No chance for her to get to the ladder before they see it.

‘I’m dying in here,’ screams the audio player in the tearoom as security guys tear a cupboard apart.

More responders are coming through the main door. Unfamiliar faces. They don’t know her either.

She grabs a student nurse’s jacket – complete with name badge: Tom – from the back of a chair, steps aside as a security guy barges in, then walks out through the open door.

‘There’s a weird guy insisting he sees you. Like, right away.’

The gum-chewing temp standing in the doorway of my office apparently hasn’t done the respect-is-expected module.

In a mental health service, ‘weird’ is normal, though we avoid both of those words when we’re talking about patients. But here, at the outpatient clinic, walk-ins aren’t so normal. However, my 9 am appointment hasn’t turned up – that’s normal – so ‘right away’ isn’t actually a problem.

Gum Chewer adds that Weird Guy won’t give his real name: calls himself Frodo.

‘Does he look –’ I stop. She said weird. Anything more specific than that is my job.

I’ve been in the clinic for three days and I’m already loving it. While I learned heaps in the Acute Unit, the work I’m doing here is closer to how I see my future. And my future is finally looking secure. I’m in the psychiatry training program. Hard to explain what a big deal that is.

My mum: ‘I thought you were already a trainee.’ (No, I was a registrar, working in a psych ward but without my work counting toward qualifying as a full-fledged consultant psychiatrist.)

My brother, Lennon: ‘Trainee? How long does it take?’ (Still five years of six-month placements plus a lot of boxes to tick.)

My sister, Mel: ‘I just tell people you’re already a psychologist.’ (Screams in frustration. Psychiatrist. I know the words are similar. But I’m a doctor, I deal with serious mental illness, I prescribe drugs … )

My dad: ‘“Registrar” sounds like someone at the council. Good to put that behind you.’ (I’m still a registrar – that’s the term for all doctors once they’re past the intern and house medical officer stages but before they qualify as consultants.)

My dad, laughing: ‘Clear as mud, Hanny.’

I get where Mel was coming from. Psychologists and psychiatrists are confused in the public mind, and there is some overlap, but things are changing. Psychiatry has been moving from lie-on-the-couch psychotherapy toward ‘real’, physical medicine – the biological approach. Scan the brain, see what lights up, prescribe the appropriate drug. Leave the talking to the psychologists.

That’s the goal, for some at least, but diagnostic tools and medication aren’t there yet, by a long way. As for leaving the talking to the psychologists, it’s not always possible.

Often, we’re the guys on the spot, no psychologist in sight, with the patient unlikely to be able to afford one anyway. So they get someone whose training in the psychological therapies is pretty much what every doctor gets taught about bedside manner. By the time I qualify, I’ll have done a bit more, but it will be measured in hours rather than years.

Even in the Acute Unit, where we were dealing with the hard end of mental illness, the biological approach by itself wasn’t always enough, or even much good at all. My boss in Acute, Nash Sharma, resisted admitting an anorexia nervosa patient essentially because we had no drug to treat her. It was our psychologist who finally made some headway, at least with the family.

Then there was our patient with postpartum psychosis. Medication and electroconvulsive therapy did miracles for her illness, but they didn’t address her troubles bonding with her baby, rejection by her husband, and fending off the mother-in-law from hell.

And Xavier, the politician. My fellow trainee, Alex, who was seeing him as a psychotherapy training case, bore most of the blame when he suicided. But there was no criticism of him being discharged from Acute with a prescription for antidepressants when his problems were way more complicated.

Now I’m seeing patients who are living in the community. Most are on medication and my first job is to review that. It’s usually straightforward, and I can use the rest of the thirty minutes – fifty for a new patient – to talk about issues arising from their mental health and its treatment, and sometimes even the causes. We don’t have as long as I’d like, and I don’t have the skills of an expert psychotherapist, but they’re not going to see an expert psychotherapist.

I feel I’ll be able to do some good and I’m planning to get better at it. I’ve got space to breathe: to extend a session if the next patient doesn’t show up; to plan my appointments. After working as a doctor for almost three years, I’m finally being treated as a grown-up.

I follow Gum Chewer to reception, where plate-glass screens give us a view into the waiting room. It’s empty apart from Mr Frodo. He’s standing – hobbit height and a ball of nervous energy. Wearing sunglasses inside. I’ve seen him somewhere before.

I push the speaker button so he can hear me through the screen. ‘Ah, Frodo?’

He smiles – possibly relieved that I don’t look too intimidating. Psychiatrists – including trainees like me – don’t wear scrubs. I’m in my usual short skirt and Doc Martens. Female, twenty-eight, medium height – just, glasses, fringe: a human welcome mat.

‘I’m Dr Hannah Wright. You wanted to see me?’

‘Yes. Urgently.’

‘Are you a clinic patient?’

‘No, but it’s about a patient.’ He lowers his voice. ‘Confidential. Matter of life and death.’

I’ve had a minute to assess him. Possibly paranoid but I don’t see him as dangerous. I have a duress alarm under my desk.

I let him into the labyrinth. The building was originally the stables and barn of a colonial house – the clinic’s official name is the Stables. What used to be the main house is now a hotel. On the other side there’s a shopping mall and we’re hidden behind a red-brick wall and a huge gum tree. Inside, the 1870s-meets-1980s-reno look is patchy and you need a GPS to navigate the corridors.

Frodo follows me to my office. According to the heritage note beside the door, it was once a dog kennel. Apparently for a small dog that had an aversion to sunlight. It’s basic: desk, computer, three green upholstered upright chairs and a Toulouse-Lautrec print.

‘So, er … Frodo, can I have your legal name and the name of the patient?’

I smile, trying to put him at ease. He looks mid to late thirties. A little shabby. He takes his sunglasses off and his eyes are pale blue.

‘No. You only need to know I’m Frodo. It’s my identity and you have to respect that.’ I don’t think that’s how it’s supposed to work, but Frodo continues before I can push it. ‘I guess you need to know the patient’s real name for the prescription.’

‘It’d be a start.’

‘Celeste Boyce.’

‘Okay. Why isn’t she here?’

‘She’s in hiding. But she needs her medication. If she misses her clozapine, it’s dangerous, right? I wasn’t messing with you: life and death.’

‘It’s certainly problematic. Are you telling me she’s not been taking it?’

‘She’s had it for the last two nights but she needs two hundred grams tonight.’

‘I’m hoping you mean milligrams.’

‘Yep. And a few weeks’ supply after that.’

‘Then I need to see her. Does she usually come here for her meds?’

‘She used to,’ says Frodo. ‘Before they locked her up.’

I look hard at Frodo. I have seen him before. ‘Does Celeste have another name?’

‘Yes,’ says Frodo, looking at the door.

‘And would that name be DJ Voices?’

He nods.

Shit. DJ was, until two days ago, a patient in our Extended Care Unit – officially the Secure Extended Care Unit. Not so secure, because she walked out of it while somebody, possibly Frodo, was creating a diversion by throwing a rope ladder over the wall and enabling other patients to abscond. All but DJ were found pretty quickly.

Inevitably the media got onto it. After starting with the danger-to-the-public angle, they switched to the human-interest story. DJ had been a rising star of the electronic music scene before being hit with schizoaffective disorder. She still performed on day leave but was apparently not well enough to live independently.

I’d gone to one of her gigs. She’d seemed to be doing okay, though watching her from a few metres away wasn’t exactly a clinical assessment. At one point she’d needed a time-out. A guy had come on and reassured us she was okay – the guy sitting in front of me now.

DJ had apparently been ‘grounded’ – the media’s word – because she’d returned to the hospital late from a gig. A nice fit with the narrative of sane person locked up and treated paternalistically that was supposed to belong to the bad old days. Unfortunately, Keith Barnard, the head of Extended Care, is a relic of those days, according to Jon Homann, another of my fellow trainees, who’s just finished a rotation with him.

‘It says in the paperwork she needs to be treated in the least restrictive environment,’ Frodo says. ‘My place may not be a mansion, but it’s not an asylum with no sex, no … privacy, nowhere to practise. We had to crowdfund her a new keyboard; the old one got wrecked by one of the patients – how can you call that a safe place? Then they punish her for being back an hour late.’

He’s barely taken a breath, and if this wasn’t so obviously something he’s passionate about, I’d be thinking manic. No; just anxious and on a mission.

‘I need to check this out,’ I say. ‘If she came back and presented her case to the Mental Health Tribunal …’

Frodo lets out a snort that shakes his entire body. ‘If we’re talking legal shit, what if you don’t give me a prescription and something happens?’

I put my hand up, and Frodo goes quiet while I check DJ’s record on the system. It confirms that she is – or was – on two hundred milligrams of clozapine a day, a solid dose for a female.

I tell Frodo I need to refer to a consultant, and he attempts a threatening look. ‘Don’t fuck with us.’

I smile and lead him back to the waiting room. And then go for help.

Louis the Locum (pronounced the French way with a Scottish accent – Lou-eh), brown hair in a ponytail, is the latest in a long line of acting heads. He gives me more freedom than Nash did – his welcoming message was basically, ‘Call me if you’re in trouble, but don’t expect much.’

I find him with his feet up in the tearoom, and explain the problem.

‘Mmm,’ he says. ‘Cannae be sure about the ins and outs of it all. Best ask the prof.’

Rather than hassling Professor Gordon, clinical director of the whole Service, I ring Extended Care.

Alex, my occasional date during our time in Acute, answers. His placement in Extended Care was a late change, probably to give him some recovery time after his psychotherapy patient suicided. That was six weeks ago and he’s basically ghosted me since.

I don’t know if it’s because he needs time out, blames me for discouraging him from phoning Xavier the night he died or wasn’t comfortable with me seeing his vulnerability and distress. Or just took the opportunity to bail.

‘Alex? Hi. It’s Hannah.’

There’s a pause. ‘Are you after me?’

‘Actually, I’m after Dr Barnard.’ The aforementioned head of Extended Care – a dinosaur in an untucked white shirt.

‘He’s in his office with the door closed. Which means do not disturb. Unless patients are climbing the wall on a rope ladder.’

There’s a flash of the old Alex there. I miss seeing him every day with his untidy brown hair and slightly retro fashion sense, taking the piss with the senior nurse and giving a running commentary when Nash sparred with management. And his intense belief in psychotherapy, which is also slightly retro. I want to ask him how he is, but I keep it professional.

‘Can you just say to me that you’ve seen the patient recently and that continuing her clozapine is appropriate?’

‘Lucky you’re speaking to me, not Keith. He’d tell you to call the police. But you were only asking about medication, right?’ He puts on a voice. ‘I believe that continuing clozapine would be appropriate.’

‘Do you think I should call the police?’

The formal voice again: ‘I believe that continuing clozapine would be appropriate.’

I laugh and ask the question. ‘How are you doing?’

There’s a long pause. Then, ‘I’m a lot better. Sorry I’ve been a bit remote, but I needed to regroup. I’d like to talk.’

‘I guess that’s what you do.’

‘So?’

‘I’ll see if I can find a slot.’

I call Jon. He was DJ’s treating doctor until the changeover of rotations this week; he’s now working in the Mother Baby Unit.

‘She’s mainly a danger to herself,’ he says. ‘Non-compliance, drug usage, risky behaviour.’

Frodo’s pacing in the waiting room. I really should check with a consultant. Which brings me back to Prof Gordon. He and I have some history. For a while he blocked my entry to the psychiatry training program, until I basically agreed I’d see a therapist myself. In hindsight, I guess it was a backhanded way of supporting my interest in psychotherapy; I doubt he’d have cared if I was planning to go down the biological–medication path.

At some point, I’ll organise that therapy. With any luck, Prof has forgotten about it.

His secretary puts me through.

‘Ah, Hannah,’ Prof says. ‘Have you found a therapist yet?’

Shit. ‘Everyone appears to be fully booked.’ So I’m told.

‘Did you tell them you’re a trainee psychiatrist? We look after each other. Try Isaac Sandler. Very experienced.’

‘I know the name,’ I say. ‘We admitted one of his patients last term. She …’ I stop. Nash had been unimpressed; she’d got better in two weeks on an antidepressant – after five years in therapy with the guy Prof’s now recommending.

‘Ah yes. Young Sophie. I believe you patched her up after a crisis,’ says Prof. ‘Don’t confuse that with solving the underlying problem. Issy tells me that losing her job was the trigger, but he’s treating the results of years of childhood sexual abuse.’

Prof has a point – the point that makes me want to learn more about psychotherapy. I explain my problem with Frodo and DJ.

‘DJ?’ says Prof. ‘The …’ He’s fishing for the word to describe what she does.

‘DJ.’

‘Right. Ask Nash.’ He hangs up.

He seems to have forgotten that I’m no longer working for Nash, who, last I heard, was on holiday in India. Looks like it’s my call.

I write DJ a script for five days’ clozapine. When I give it to Frodo, I tell him to bring her in on Monday.

‘Nope,’ he says. ‘The longer she’s out, the less anyone will be chasing her.’

‘Then you’ll have to come in.’

I give him my number; not something I’d normally do, but it’s in my interests to give him every chance to do the right thing. I’m already feeling uncertain: why did Frodo choose sex as the example of something DJ couldn’t have in hospital? He presents like everybody’s idea of an incel.

As he leaves, I call after him, ‘Why did you ask to see me?’ There are two other trainees at the Stables.

‘I didn’t. I asked for the youngest doctor.’

An hour later Keith Barnard calls me from Extended Care. ‘Where is she?’

‘I don’t know.’

‘What do you mean you don’t know?’

‘Frodo wouldn’t tell me.’

Silence, then: ‘Frodo?’

‘Er, it’s his … identity.’

‘His what? Did you call the police?’

‘Um, no.’

‘What did you do?’

‘I gave him five days’ worth of clozapine.’

‘Who told you to do that?’

‘I couldn’t reach anyone. I had to make a call.’

‘Well, you made the wrong call. If he comes in again, ring the police.’

I don’t hear him slam the phone down but … yeah.

—

There’s a meeting to announce the new organisational structure for the Menzies Mental Health Service and now I’m going to be late. I jog the kilometre from the Stables to the main hospital campus with its steel-and-glass towers for the surgery, obstetric, general medicine, cardiac and oncology units, and the run-down original buildings which house the central mental health services. It’s late winter and bitterly cold.

A trolley with an unconscious patient, IV fluids attached, rolls past as I enter the lecture theatre. Everyone’s still taking their seats. There’s maybe a hundred of us: doctors, psychologists, social workers, one occupational therapist, senior nurses and a few admin staff.

Nicole Ogilvy, short, even in her regulation high heels, hair in a neat twist, is tapping her toe beside the podium. She’s in a slim-legged suit today – a poster woman for power dressing. She’s the admin director and it’s her meeting.

I spot Alex and Jon near the front. Alex is in a turtleneck and jacket, hair now over his collar but swept back. He looks thinner, less boyish. Jon is in chunky boots, sports jacket and baggy jeans, shaggy hair now almost as long as Alex’s. A Bilinarra man, three thousand kilometres from his family in Darwin. I’m not sure he’s settled into Melbourne yet.

‘Nicole’s been in the job six months,’ says Alex when I join them. ‘She’s ready to make big changes. Take out some enemies.’

‘You’re thinking Nash and Prof?’ I say.

It turns out Nash is back from India, after being forced by Nicole to take his accumulated leave and by his wife to take it in the country of their birth. He and Nicole regularly butt heads, but I think she respects his competence. Prof Gordon was meant to retire when Nicole was appointed, but managed to hold on to half of his old job.

Prof finally arrives: suit, tie, clipped Freudian beard. He glances at Alex. Some of the responsibility for Xavier’s suicide has stuck to Prof, who was Alex’s supervisor.

Unexpectedly, it’s he, rather than Nicole, who steps up to the podium and clears his throat theatrically.

‘As I’m sure you’re aware,’ he says, ‘this is a time of change in mental health. We are under pressure to implement the initiatives arising from the Mental Health Commission review …’

‘… while continuing to provide the high-quality …’ It’s Alex in my ear: not quite the words Prof’s saying, but near enough.

I manage not to laugh. But I’m watching Prof’s body language – waiting for him to blink twice to tell us he’s being held hostage.

‘Nor can we afford to neglect the development of the next generation of psychiatrists. Accordingly, I have decided that my current roles should be split. I will continue to lead research and training …’

‘Shafted,’ says Alex, still in my ear. I’ve missed the closeness.

‘Dr Sharma will take over the operational aspects of my role. I will remain at arm’s length, except in the event that an issue of overall governance arises.’

So, half right. Prof has been sidelined, but Nash has been promoted. Which, I guess, makes him ultimately my boss, but I’m thinking – hoping – Nicole’s plan is to load him with so much work that he won’t have time to get in her way. Or mine.

Prof hands over to Nash. I can’t tell if the break has done him any good. He looks just the same. Same open-neck white shirt, dark trousers and jacket. Same movie-star eyes and smile.

Nash thanks everyone for the vote of confidence, tells us he’ll be open to suggestions, and the meeting breaks up. Back to work.

I’m about to suggest a coffee to Alex, but Nash collars me. Keith Barnard is with him, ill-fitting trousers belted below his gut. Only he and Prof wear ties, but Keith’s is loose around his neck, top button undone.

We huddle in a corner of the lecture theatre while doctors in scrubs are coming in to replace the psych staff in street clothes.

‘What happened with Celeste Boyce?’ Nash asks me.

I explain carefully: Frodo’s visit, the time pressure, putting the patient’s needs first.

‘Why didn’t you talk to Keith?’

‘He was in a meeting.’

Nash raises an eyebrow. ‘Keith?’

‘My registrar should have interrupted me. Alex Ashwood. Not the finest judge of a situation. He apparently knew the patient was planning to abscond but didn’t report it.’

Keith is watching Nash’s response. I get the sense that they don’t actually know each other well. Nash doesn’t say anything.

Keith crosses his arms. ‘We’d just got her on an even keel. Her weekends out were destabilising and I’m concerned that she was – and now is – being taken advantage of. She’s with a group of heavy drug users.’

‘You know this?’ says Nash.

‘Let’s not be naive. She’s in the electronic music scene. Which is all about drugs. And I know this because I’m the one who gets to see them after they’ve fried their brains with methamphetamines.’

Keith leans into me. ‘But we’re talking about Celeste specifically, who’s a shining example. Schizoaffective – possibly triggered by so-called party drugs, but definitely exacerbated by them. Sexually transmitted diseases. Termination that nearly killed her. She’s not safe.’

Now he’s lecturing me.

‘Nobody’s disagreeing that we needed to get patients – some patients – out of the long-stay wards. Government saved a lot of money. But it hasn’t gone back into supporting them in the community. You only have to walk down the street to see where they’re ending up. If the Stables was doing what it’s supposed to do –’

Nash interrupts, turns to me. ‘Do you have a plan to review her?’

‘In five days, I’ll speak to … her friend again.’

‘Right,’ says Keith. ‘Frodo the Frog.’

Nash raises a hand. Enough already.

‘Wait,’ says Keith, addressing Nash. ‘I want us to be very clear that Dr Wright has taken it upon herself to disregard what people senior to her, who have assessed the patient over an extended period, have decided in the past and would have wanted her to continue. If anything happens to Ms Boyce –’

‘This is the case that’s been in the media?’ It’s Nicole, who has apparently been listening to us while talking with the hospital medical director.

Nash nods.

‘Correct me if I’m wrong, but I’m hearing that, not for the first time, a junior doctor has been left without support to make a consequential and, in this case, visible decision – in part, because we’re still relying on locums to run the Stables. Am I right?’

Nash nods again. ‘Louis –’

‘I want you to make it a priority to fill that role. In the meantime, I’m going to ask you to take responsibility for this case.’ She pauses. ‘And the Stables.’

And, just like that, Nash is now my direct boss.

Keith looks at us smugly.

Nash looks right back. ‘Keith, I take your point about needing to do a better job of transitioning long-term patients to the community. Would you like to schedule two sessions a week in the clinic to help me with that?’

It’s not a question and Nash doesn’t wait for an answer, instead accompanying me on my walk back to the Stables.

I’m a bit shaken, and he does his best to make light of it. ‘First half-hour in my new job and I freed up a long-term bed.’

We walk for a while in silence, then he adds, ‘Not ideal you being supervised by a locum. If I’m going to be running the clinic, I’ll take over that role.’ He smiles. ‘If you’d asked me about Celeste, I’d have said “make sure she gets her meds”.’

—

Alex texts me: Quick drink 6pm?

I text back: Does it have to be quick?

No point playing games. . .