r/emergencymedicine 3d ago

Advice Verbal approach to involuntary psych patients

/r/nursing/comments/1n0op3b/verbal_approach_to_involuntary_psych_patients/
6 Upvotes

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u/Old_Glove9292 3d ago

Gentle reminder that the World Health Organization considers both forced restraints and involuntary hospitalization to be human rights abuses, and is advocating for those interventions to be banned globally:

https://www.who.int/news/item/10-06-2021-new-who-guidance-seeks-to-put-an-end-to-human-rights-violations-in-mental-health-care

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u/Negative_Way8350 BSN 3d ago

Gentle reminder that patients assault nurses at extremely high rates and do you have any suggestions for our own right to be safe on the job per OSHA? 

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u/CrumbCakesAndCola 3d ago edited 3d ago

It's a nearly 300 page document of suggestions yes

https://www.who.int/publications/i/item/9789240025707

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u/Negative_Way8350 BSN 3d ago

Nope. This is a page of things for patients. 

Some patients will assault staff no matter what. What options do you have FOR STAFF?

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u/Throwawayyawaworth9 3d ago

I’m thinking about the time that I was sexually assaulted by a patient.

After every possible attempt at verbal deescalation and medical sedation was made, should we have left them unrestrained to continue assaulting me and other staff? Or should we have let them out into the community to continue those behaviours elsewhere?

It sucks for patients, but restraint is sometimes necessary to protect both patient and staff safety. Unless you or members of the WHO have had their skulls smashed in or have been SA’d by a patient, I don’t think your opinion really matters.

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u/Negative_Way8350 BSN 3d ago

This is exactly what people who don't do the job understand. De-escalation fails. A lot. More than we are all willing to accept.

I submit the idea is that it's because these assaults are not driven by being "out of control" but in fact being very in control with rage and animus directed in a surgical way towards medical staff. The patient is not a victim helplessly acting out their feelings. The patient is an assailant who sees medical staff as non-human and thus deserving of pain, suffering, and profound boundary violations.

In that sense, we as human beings have every right to respond to such force with such reasonable force to keep ourselves safe.

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u/Competitive-Use-3555 2d ago

AMEN to that! People outside of the profession just shout be writing policy about contingencies like if Bobbi Sue punches you in the breast, then attempt to escalate Bobbie Sue for 10 minutes even if she continues to use your breasts for punching bags, blah blah blah blah blah…it’s all absurd.

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u/FriedChickenIsTrash2 Physician Assistant 3d ago edited 3d ago

Put the World Health Organization bedside and let them deal with a combative GHB/polysubstance overdose without restraints and see how quickly they change their minds on banning restraints

6

u/Rita27 medical assistant 3d ago

Yep, there’s a reason nobody really took that report seriously when it came out. The truth is, there is still a place for involuntary treatment. Even in Trieste, which is praised everywhere including by the WHO, it is still used but only very sparingly.

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u/BikerMurse 3d ago

Guess I should let my patients go kill themselves and/or others so I don't violate their rights, then.

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u/Rita27 medical assistant 3d ago edited 3d ago

Some people honestly think it’s better for a person with schizophrenia to be covered in their own feces and hurting themselves or others than to be on involuntary treatment. It’s easy for them to say that because they know they’ll never actually be in a situation where they have to pick between someone’s safety and their liberty.

Some people even suggest a jail for these types of patients. which is genuinely baffling

Apparently it's much more humane to have cops restraint and imprison someone who is psychotic than mental health staff. So unserious

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u/IcyChampionship3067 ED Attending, lv2tc 3d ago

Your complete lack of compassion and human decency is astounding.

Allowing disoriented, psychotic patients to demand to wander off into the snow is beyond cruel.

Are you so foolish that you don't understand that a lot of insurance doesn't cover a voluntary stay? You do realize that hospitals aren't going to just someone who doesn't meet the 5150 criteria and doesn't have any way to pay, right?

Seriously, what color is the sky on your planet. I but it's a lovely soft pastel ....

Oh, looks like you have a reading comprehension or honesty problem. That explains a lot. From the link:

"The new guidance, which is intended primarily for people with responsibility for organizing and managing mental health care, presents details of what is required in areas such as mental health law, policy and strategy, service delivery, financing, workforce development and civil society participation in order for mental health services to be compliant with the CRPD."

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u/Throwawayyawaworth9 3d ago

I saw your comment suggesting we call the police (not sure if you deleted it? It’s not appearing anymore). But what would you expect the police to do? We staff peace officers at my hospital. They assist with restraining patients.

So your solution to nurses not restraining patients is to… instead have police restraint patients? Calling the police to press charges would not lead to the patient going to jail if that’s what you’d hope for— they still require medical treatment. They are instead handcuffed or soft restrained to the bed for the duration of their medical treatment, which imo is worse than restraining someone momentarily during a crisis until their treatment is complete and they regain their impulse control.

Restraints are not a form of retaliation— my goal is never to punish my patients, but to protect the safety of myself, my colleagues, and the patient themselves.

I will agree that restraints are sometimes used unnecessarily, but to state that forced restraints are always abusive or are a form of retaliation, rather than protective for staff and patients, is incorrect and perpetuates the idea that nurses should just tolerate physical abuse by patients, even in cases where the risk of physical harm is moderate to severe.

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u/Competitive-Use-3555 2d ago edited 2d ago

Licensed Independent Clinical Social Worker here: I just wonder…What have these folks done outside of the hospital to warrant an involuntary hospitalization (often escorted to the ER by ambulance or EPC’d by the police) or on the unit to meet the very strict criteria for forced restraints? I’d love to have the WHO peeps who wrote this crap to come on over to the county hospitals, community ERs and psych floors on a full-moon Friday night to observe first hand who’s rights are being violated by whom. For them, it’ll be a nail-biter all the way to the end of the shift or until one of them gets head-butted in the groin.

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u/backroundagain 15h ago

You either say something like this, or have experience treating these patients. Not both.

No one has an ounce of interest hearing an opinion prefaced on zero experience.