Verbal approach to involuntary psych patients

[u/strawbqu]

I am a newer ER RN in Canada, I’m looking for advice on approaching patients that are placed on an involuntary hold. Specifically with approaching an individual with restraining and chemical sedation (I know.. seems brutal but if you know you know. I’m not sure if this is legally relevant in all countries but it’s how we do it here). I find it difficult particularly with paranoid and manic patients. What is your spiel for the reasoning of the intervention, when you especially know they need it and they are refusing (and ultimately will have no choice but to take the medication and/or be restrained)

I tend to start off with the fact that the doctor needs them to take sedation.. if they are compliant they will not need to be restrained etc..

[u/Old_Glove9292]

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

[u/strawbqu → u/Old_Glove9292]

In a perfect world, I would totally agree. But when you have someone charging around the emergency department climbing the walls, throwing chairs at people, spitting in the faces of other patients.. that is unfortunately not safe for anyone. But it is always a last resort.

[u/Old_Glove9292 → u/strawbqu]

Spitting in someone's face is assault. I agree that shouldn't be tolerated, but restraints and involuntary hospitalization are not the answer. Call the police.

[u/strawbqu → u/Old_Glove9292]

Do you believe you’d have the same opinion if you or a loved one was being assaulted while hospital staff watched and waited 10-15 minutes for police to arrive while you fend for yourself?

[u/Old_Glove9292 → u/strawbqu]

Absolutely. Two wrongs don't make a right, and security should be equipped to handle unruly patients until the authorities arrive. Don't take my word for it. It's the official stance of the World Health Organization.

[u/strawbqu → u/Old_Glove9292]

I genuinely hope for the safety of both the public and the patient that this does not become the standard. I would not expect anyone who has not experienced what it’s like to understand why.

[u/Old_Glove9292 → u/strawbqu]

I would expect a prison guard who has abused criminals to use the same line of reasoning... Wrong is wrong. Period.

[u/flannellavallamp → u/Old_Glove9292]

Do you think the police aren’t restraining them? They’re getting restrained one way or another - it’s better to be restrained under the care of medical professionals than put in a straight jacket in a prison cell.  Your being a bit delusional here.

[u/Old_Glove9292 → u/flannellavallamp]

No. What's delusional is thinking that there's any reasonable justification for human rights abuses... Detention and prosecution are functions of law enforcement and not medicine-- period. This is basic common sense, which unfortunately, I'm realizing many clinicians desperately lack. Don't be Nurse Ratchet...

[u/flannellavallamp → u/Old_Glove9292]

Restraint is a function of medicine. People can and will hurt themselves and others in a variety of situations.  Prison and jails literally employ nurses to administer chemical restraints.

[u/Old_Glove9292 → u/flannellavallamp]

Then you just answered your own question. That function should be performed in a correction facility following due process and a court order. It absolutely should not be subject to the whims of "clinical judgement" in a hospital.

[u/flannellavallamp → u/Old_Glove9292]

They’re not giving court orders to restrain people in prison lmao. You are being incredibly naive. Once one is detained your restrained as necessary chemically and physically to protect employees, prisoners and yourself at the discretion of corrections staff and clinical judgement of a nurse. 

[u/Old_Glove9292 → u/flannellavallamp]

Obviously... but court orders are required for sustained detention including involuntary treatment, and once detained, individuals are ultimately under the supervision of the judicial system, which follows due process. You are being incredibly dense.

[u/Old_Glove9292 → u/flannellavallamp]

Obviously... but court orders are required for sustained detention including involuntary treatment, and once detained, individuals are ultimately under the supervision of the judicial system, which follows due process. You are being incredibly dense.

[u/flannellavallamp → u/Old_Glove9292]

Your dense if you think court orders are any better than a medical professionals clinical judgement on whether a person should be restrained LOL  you have a weird amount of faith in the courts.