Mental health and the ED…

Every patient deserves the same kind treatment regardless of why they come to the ED, but do they get it?

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Surprisingly patients experiencing mental health crisis are a huge percent of patients coming the emergency room and often the ones left sitting and waiting. In all the places I have worked, the number of patients seeking psychiatric assistance in the ED is a concern and, in my opinion, needs to be addressed. A growing number of psych emergencies and not enough resources, beds, or treatment options, leaves this vulnerable population with anywhere else to go during a crisis. And because of the lack of options, these patients can wait for hours or even days waiting for a more appropriate place that will give them the help they need and deserve.

Often whfullsizeoutput_1ee6en a patient experiencing a mental health emergency presents to the ED, it is our job to rule out medical issues and clear them to go to a mental health department. These patients are often in severe crisis, perhaps paranoid, perhaps drug induced, and may also be physically injured. This is when mental health patients are most vulnerable and also the time when ED nurses feel the most unprepared. As an ED nurse, my training is focused on life saving measures…ABC’s! But, my training lacks on how to manage a mental health crisis! If my patient has overdosed, I 100% know how to manage their airway, but if they are hallucinating, paranoid, or suicidal, do I have the skills to do a good job?

Before leaving to work in the USA, my experiences with mental health patients was limited and superficial; however, that all changed when I arrived in Colorado. While in WA state, I cared for a few patients with alcohol intoxication and while in IN, I cared for a few patients with Heroin dependency; however, I had never seen the likes of mental health in Colorado!

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My first CO assignment broke me into the world of mental health nursing like non other! The hospital ED had a 5-bed locked unit, and we often housed 2-5 more mental health patients in the regular department. Each shift at this facility challenged my entire way of nursing and my own mental health.

One particular night, we had a patient arrive with a dangerously low blood sugar level. This person required immediate intervention of IV dextrose. Initially, the patient was unable to communicate with us; however, once the blood sugars began to rise the patient realized they were in the hospital. Instead of being grateful to be alive, this person was more concerned about their belongings which were likely left where the ambulance had picked them up. The patient became enraged that the belongings would be stolen. As the kind nurse I was, I contacted the EMS crew in an attempt to locate the belongings, the crew went back to the scene and picked up all the stuff (including a bike) and returned all the belongings to the ED.

Instead of being thankful for both their life and belongings, this person chose to threaten my life and was holding me personally responsible for all of their belongings. After overhearing this person on the phone, telling friends to get their weapons and come pick them up from the ER and “take everyone out”, my fear level was higher than I can ever remember. And even many hours after the patient left the ED, I had security walk me to my car. Yes, this incident was reported to the police but due to the homelessness and mental health issues, it was near impossible to ensure this person would be found to be charged. I had many more incidences at this hospital, but I’ll tell you about them another time.

I felt incredibly vulnerable and under-skilled to deal with this population to begin with and this experience only reinforced this for me!

What’s your experience with challenging populations or situations? I’d love to read your stories, please feel free to leave a comment!

fullsizeoutput_1e3c Trudi

(some images are obtained from google, no copyright infringement intended)
(patient confidentiality is of upmost importance, patient identifiers have been removed to ensure patient privacy and to protect HIPPA/FIPPA laws)

(https://www.modernhealthcare.com/article/20190128/NEWS/190129944/emergency-rooms-fill-up-with-psych-patients-and-then-they-wait)

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