Mental Health is an area that certainly needs improvements along with properly trained professionals. These professionals whether nurses, social workers, physicians or administrative staff need regular skill upgrades provided by their employer, of their own choice/initiative or as required through the state, province or the profession itself.
Below is an example of what should not happen when an individual who has a history of depression goes off their medications of their own doing, exhibits behavior that causes one to pause and asks for help to make changes to this downward spiral.
A patient goes to his physician and shares that he has stopped taking his lithium and Paxil, admits to having returned to the habit of drinking one or two six-packs daily and more on weekends, stopped going to work and was fired. This man has no energy or ambition, is not sleeping well and recently had gotten angry with a neighbor and tried choking him. When asked him if he had other times when he considered doing things that might harm others, he said he had been driving around with his loaded gun, feeling very angry and wondering if he would feel better if he shot somebody, and whether it would be better to shoot somebody he knew or a stranger. Are these not warning signs that something serious is going on here! That little red flag should be in each of our minds with this information.
The man and the physician talk briefly about the fact that the medicines might have stopped working because of the alcohol, but that he was now dangerously depressed, and that the options were to go directly to the crisis unit for admission or, if he refused, I would call the police. He readily agreed to admission. “That’s why I’m here doc. I need help before it’s too late.”
His wife drove him straight to Crisis in the hospital across town, where he was evaluated. They called and told me the decision had been made to admit him.
Now, without relaying more information-what are your thoughts? What do you think will happen once he is at the hospital? Will he be admitted, sent way with a prescription or kept for observation until the morning? Which professional will make this decision and what is the reaction of the physician who convinced the patient to go to the hospital?
Below are excerpts–
He had been seen and evaluated by the nurse practitioner on call, was felt to be seriously depressed and “at major risk for harming himself or others.” It was late in the day, there was no bed available on the psych floor, and the psychiatrist had left for the day. The man was kept overnight in the emergency room for admission in the morning. During that time, he underwent the standard and metabolic screening and physical exam by the emergency room physician whose note confirmed the patient’s description of events.
Early Saturday morning he was visited in the ER by an intake worker. She reviewed the chart and spoke to someone on the psych floor, after explaining he did not need inpatient care. The man was discharged home with (written) instructions to see his primary physician to restart his medications. He was also told to call for an outpatient counseling appointment.
The phone call was made and he was told that the counseling sessions were booking into the fall and he would be put on a waiting list. If services were needed sooner, he should contact his primary physician or return to the Crisis Unit in the ER.
This is the unfortunate reality today. Not enough Mental Health workers to provide needed services, untrained staff, wait lists, budget cuts and it is the individuals suffering from mental health issues that are left to their own devices and every country has been witness to the types of tragedies that occur because of the above.
It took another 5 days before this man was admitted to the psychiatry floor of a local hospital, friends and family stepping in to provide assistance and a caring physician. What about those without friends or family? Those without a family or primary physician? What about those individuals who do not seek help and do not recognize that their life is taking a downward spiral?
No country can afford to continue along its current path of reducing services or having untrained professionals. Mental Health issues are increasing not decreasing! Has the world not learned from all the recent shootings?
Any individual who tells a professional or goes to a hospital or clinic seeking help because there is admitted risk of hurting/harming self or someone else, needs to be admitted for observation and placed in a safe environment. No bed in psychiatry? Place them in another bed, keep them in the ER, contact the physician who helped with the original admittance. DO NOT send the person home.
*Written by Victoria Brewster, MSW
Staff Writer in Canada
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Prior to returning to school for my master’s degree I worked in the county Probate Office assisting with petitions for commitment due to serious threat of harm to self or others. Almost always there was a very long list of people waiting to be taken to the hospital through police intervention. The local sheriff would only pick up one per day and that only on days he had extra personnel (which was maybe twice a month). People who knew the judge or that had politically influential families were generally moved to the top of the list. If and when these serious mentally ill people were picked up, hospitalized and committed, they were sent to the only psychiatric hospital in the area. There they remained until their medications were restarted. They were/are then released,(about three weeks) where the cycle continues on and on and on. I noticed during this time period that several of these very sick people showed up in the county jail after being involved in altercations or attempts to carry through their delusional actions. At least two of them were killed following attacks on police officers while chained and shackled. I realize the economic state of our country and the necessity to prioritize resources, however I have trouble justifying the killing of a mentally sick individual simply because they were not picked up or hospitalized and their situation stabilized.
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