r/emergencymedicine • u/strawbqu • 3d ago
Advice Verbal approach to involuntary psych patients
/r/nursing/comments/1n0op3b/verbal_approach_to_involuntary_psych_patients/10
6
u/Nurseytypechick RN 3d ago
"Your behavior is not safe for you and everyone else. If you are not able to show safe behavior, we will need to give you injected meds and place you in restraints until you are able to safely regain control of your actions.
This is to keep you safe. You are not being punished. You are not in jail. Once you are able to be safe again we will get you out of these restraints."
Less words if less decisional capacity but maintaining calm statements and giving info and reassurance
2
u/Competitive-Use-3555 2d ago
Psychiatric Clinical Social Worker here: We let these folks have their rights to self-determination right up until our sadly past the point that their rights interfere with the rights to privacy, safety, freedom and liberty of the public at large (1 or more) being infringed upon in violent ways-and this benefits whom? The mental health system in the US is failing mentally ill individuals—Thanks Managed-Care Organizations (MCOs)—as well as the addicted, and when we fail them, they fail us except they don’t know the rules to the game being played. And EVERYONE Loses-some more than others.
1
u/strawbqu 1d ago
This does not answer my question
1
u/Competitive-Use-3555 1d ago
Sorry, I wrote this while I was half asleep and honestly don’t remember reading your post. I was, I think, responding to someone else’s reply. So sorry!
1
1
u/PanDulcePorVida 2d ago
SW/grad student here. Having worked for years in locked psych units, I've learned that the most straightforward and compassionate approach is the best. The best LCSW I ever saw basically would say "I am concerned for your safety and well-being because of (insert behavior, comments/threats about SI/HI, etc) and I am going to admit you on a hold so that our team can care for you and evaluate your needs further." He'd then go on to explain the hold, their rights as a patient, and what they could expect during their stay. It takes some time and many patients raged anyways but it covered all of the bases. Involuntary holds can be traumatic for everyone, I have a lovely bite scar on my right forearm to prove it BUT sometimes they are absolutely necessary.
-32
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:
46
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?
-9
u/CrumbCakesAndCola 3d ago edited 3d ago
It's a nearly 300 page document of suggestions yes
14
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?
18
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.
12
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.
1
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.
30
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
12
u/BikerMurse 3d ago
Guess I should let my patients go kill themselves and/or others so I don't violate their rights, then.
6
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
6
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."
7
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.
1
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.
1
u/backroundagain 22h 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.
-34
u/No-Flatworm-404 3d ago
I was a sophomore in college, living in the dorms, and I was dealing with BPD and deep depression. They bought me to the ER, because the Dorm Staff went into crisis mode and sent me to the ER. ER Doctor asked why I was there. To be honest, I really didn’t know, I was pretty depressed and just plain out of it. Doc was upset, left the room and told someone within earshot of me, “I didn’t go to med school for this”. I was like, great, I pissed the doctor off for telling the truth. I told the nurse what I overheard and that was the last the time I saw him. So, don’t be that doctor.
21
u/Negative_Way8350 BSN 3d ago
This sub isn't for patients to complain.
10
u/strawbqu 3d ago
Exactly, while I’m sorry this happened to this person, I feel like it’s pretty clear that my main goal here is to find ways to not be that guy
-16
u/No-Flatworm-404 3d ago
And, that’s all I was pointing out. Wasn’t complaining. No need to complain when I was just stating the facts.
15
u/IcyChampionship3067 ED Attending, lv2tc 3d ago
If I came into your support group and started telling everyone about my problems with people like you, I'm pretty sure you'd be unhappy about it.
That's what you've done here, and it's absolutely inappropriate.
Do not do it again.
40
u/Negative_Way8350 BSN 3d ago edited 3d ago
Well, first of all that's a conversation that psych needs to be having with them. Not nursing.
But unfortunately I have been placed in the situation that goes like this: Psych walks in, states the fact that they are involuntarily admitted. Scurries away. Patient promptly loses every single shit possible and now it's my mess to clean up.
My spiel often goes: "Hey, I hear that this is really hard to listen to. You don't want to stay. I get it. However [and this part I usually need to raise my voice a bit for because they're screaming] this behavior will not change that fact and it can result in you being restrained. I don't want to do that. I want you to be able to have a sandwich, and a blanket, and go to bed. You do not have a choice about staying. You do have a choice about your behavior."
Then we usually go in circles for a little bit while they rage and scream and call me every name in the book. That I can deal with. Odds are about 50/50 that they will settle and we can get somewhere or I will need to break out the night-night juice.
I don't mind if they're angry about it. I sympathize, especially if they're held on a Friday because that will be a miserable weekend while they wait to have their hearing (and frankly, I think that's a violation of rights). But I don't tolerate them hurting themselves or threatening/trying to hurt me or anyone else.
If it's just meds and they don't want them, I say, "Hey, so not taking the medication is not an option. But I do want you to have choices. Which arm would you like it in?" Again, about 50/50 odds of them continuing to adamantly refuse and then we just have to go for it. But sometimes patients do say, "My right arm" and then we've retained some degree of rapport. I explain that their behavior is unsafe and I list specific examples so it doesn't just feel like they're getting drugs for no reason.