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/arcanistmind → u/Old_Glove9292]

The article you provided is a summary about the guidelines which seek to end human rights abuses, but you're likely conflating the language and interpreting restraints as the human rights abuse. Hopefully this does not come from personal traumatic experience in healthcare with restraints for you or a loved one.

The language on restraint and use of seclusion or isolation in the actual guidelines is far less strict where it calls for monitoring for use rather than an outright ban on these things as limited use of them when acutely necessary for the immediate safety of the patient and providers alike is generally considered appropriate standard of care when paired with patient safety monitoring and appropriate de-escalation.

Sorry you're being downvoted into oblivion for passionate defense of patient autonomy and human rights.

Source for the full 2020-2030 WHO guidelines: https://www.who.int/publications/i/item/9789240031029

[u/Old_Glove9292 → u/arcanistmind]

I appreciate you. Thank you for treating this matter with the gravity that it deserves. On page 17, I read "prevention of coercive practices", which includes any form of restraint or involuntary hospitalization, to mean a ban on those type of interventions.

"Human rights standards include provisions for: (i) transition to mental health services based in the community, (ii) promotion to exercise legal capacity, (iii) prevention of coercive practices, (iv) procedures to file appeals and complaints and (v) regular inspections of mental health services."

And from this source:

Ending coercive practices

Ending coercive practices in mental health – such as involuntary detention, forced treatment, seclusion and restraints – is essential in order to respect the right to make decisions about one’s own health care and treatment choices.

Moreover, a growing body of evidence sets out how coercive practices negatively impact physical and mental health, often compounding a person’s existing condition while alienating them from their support systems.

The guidance proposes legislative provisions to end coercion in mental health services and enshrine free and informed consent as the basis of all mental health-related interventions. It also provides guidance on how more complex and challenging cases can be handled in legislation and policies without recourse to coercive practices.