On Fridays I will address a basic psychiatric question and find the answer from an expert. If you have a question you want answered, please ask it on the combox of this post, and I'll try my best to do some research and feature it in an upcoming Friday post.
The NAMI Maryland publication, "Connections," recently published this question:
I was recently faced with the dilemma of whether or not my wife was a danger to herself and others, and whether or not to take her to the emergency room as a psychiatric emergency. Are there any guidelines or suggestions as to when its best to take a loved one to the hospital?
Dr. Mark Komrad, M.D. responded:
This is one of the challenging issues in all of psychiatry--both practically and ethically. So I can only attempt to address it in a most preliminary fashion in this article. The easy answer is: call your wife's psychiatrist. I believe that all physicians should have a system to be available in the case of possible emergency. That is a fundamental ethical principle we are taught in medical school. Every patient and family should be familiar with how to contact the psychiatrist in the case of emergency.
One of the most common reasons psychiatrists are reached in an emergency is to consult on just this situation--whether or not a person should go to an emergency room (ER). As a part of residence training, all psychiatrists have extensive experience with this scenario.
What if the doctor can't be reached or if there is no psychiatrist on the case ... yet? The primary concern is safety--hers and yours. If there is any question that your wife is unable to control her behavior to maintain safety, it is reason enough to have an evaluation in the ER. Safety includes considerations of violence to self and others, as well as other kinds of safety such as fire safety, fall risk, or medical risk. A diabetic who is refusing to eat, a person with unstable hypertension who is highly agitated, a person who has fallen into an unmoving catatonia and isn't acting to take care of his basic needs, a person who environment has deteriorated to a fire or health hazard: these are all examples of various cases from my own clinical experience that have been appropriately brought to the ER. So, if the doctor says go--go. If you feel there is a risk of harm afoot -go.
A final consideration in your decision: if someone has never been in for treatment, an ER evaluation can open the door to mental health treatment, and is sometimes the only first step a person is willing to take.
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I feel that hubby should definitely take to hospital - there had to be concerns or signs of "doom" type behavior for hubby to question. Better to be safe than sorry. My motto is "when in doubt, check it out!" do what your better instincts are telling you.
How does HIPAA affect this?
Sometimes the most loving thing we cando for our spouse and/or children is to create a "reaity check" that can't be denied or ignored. In my mind,this goes back to the question of treating metal illness on equal footing as a physical malady. If it was the body more than the mind in crisis, one probably wouldn't even question the appropriate action. For example, if an individual had an obvious heart attck or was bleeding uncontrollably due to an accident, the ER is EXACTLY where most of us would turn even if our spouse or child didn't want to go. Could ETs not help in this kind of scenario as well if no psychiatrist is already treating this individual.? Calling 911 and being candid abouth the "nature of the emergency" should result in bringing trained professionals to the scene, should it not? Although individuals often fight ER visits even if the problem is 100% physical, the ability of first responders to talk to ER personnel for guidance usually results in transport regardless if those trained professionals deem it to be necessary. It might not be the ideal solution, but it's been my experience that loved ones will sometimes listen to the objectivity of "outsiders" when they refuse to heed family members.
Going through the ER, involuntarily, is not only the most traumatic of experiences a mental health patient can experience, it has the most far reaching of consequences, and is the most expensive. I believe there should be special protocals to gently bring a person in a mental health crisis to a mental health facility. If this proves impossible, then mental health professionals should be willing and able to go to the patients home and offer treatment which will enable the patient to either safely remain at home or safely, without mental or physical trauma, to go to a mental health facility. ER's can often be the most traumatic of places. Even if the local ER is a safe place, a person in mental crisis will most likely perceive going to the ER to be an extreme and fearful experience. Calling 911 ordinarily brings policemen, not mental health professionals, into the already unstable person's home, generally causing them to panic. Is it somehow Illegal to be in a mental health crisis? Then why are there cops every where? This person has probably done nothing illegal. How traumatic for him/her!
This is, quite simply, a tragic, traumatic thing to make both family/friends and the confused, and now terrified person to do.
We must stop making it illegal to be mentally ill, as it appears we do. We must stop treating a person with a broken heart/mind like they merely have a broken leg, or like they have done something wrong.
I know whereof I speak. I have been through the ER, been through both voluntary and involuntary commitment, been arrested and put in jail, having harmed neither myself or anyone else when all that is needed are special, gentle, professionally written protocals for handling persons in mental health crises. We now force these poor, confused people to say they want to hurt someone, just to get... what? Thrown in jail, sounds like they're are going to jail or some kind of lockup to me. At the very least could we send plain clothes policeman, the kind without all the guns and clubs,instead of the kind we see beating on people, shooting at people and arresting people, putting them in all kinds of lockups, the kind of "peace" officers we see on every TV in America.
The mentally ill are, generally, the most peaceful of people. The want to stay home and try to relax, or just take a walk, remember to take their pills right, to try to calm the chaos in their heart and soul and mind. And when things get a little scary, what can they do? What if its after Dr.'s hours, or on a weekend?
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