Managing patients with phyciatric issues

[LanceCorpsman]

Had a patient today who has been in and out of rehab for drug abuse. Patient has had suicide attempts and has OD'd a few times. This patient has some obvious mental issues and is seen by behavioral health specialists.

Because of my lack of experience, I usually feel useless and don't know how to approach these patients. I'm not talking about the obvious things like being nice and empathetic. Since they are mentally unstable, I assume I have to be really careful on what I say and how I approach them to keep the patient and myself safe.

Are there any resources that I can read up on to improve on my skills of dealing with these patients? What are your strategies on dealing with them?

 

[VentMonkey]

What skills do you feel you lack? A cautious approach is probably my best advice, but they're people just like you and I, treat them like such.

 

[NysEms2117]

There are a lot of tools and resources I use for my main job. Granted part of my college education contained said resources. However if you have specific questions I may be able to help because I have to be a mental health councilor to be a P.O.. Not that the particular certification means much

 

[LanceCorpsman]

Well this particular patient ran away from the rehab center and went to her relatives house, stole the drugs out of the cabinet. Idk, I just had a very hard time convincing her of going back to the hospital. I feel like if I knew more about mental disorders and had some counseling techniques, i could have done it much better of talking to the patient.

 

[NysEms2117]

Well something I learned very early on is the fact you can't really convince them... They do what they want. there are techniques you can use to help persuade them. I find if you try to befriend them and play a game of give and take that works best. When I get around to it I'll give you a few links.


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[LanceCorpsman]

Well something I learned very early on is the fact you can't really convince them... They do what they want. there are techniques you can use to help persuade them. I find if you try to befriend them and play a game of give and take that works best. When I get around to it I'll give you a few links.


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That would be nice. Ive been trying to look for stuff on google but I don't know where to start. I am not trying to be a coucelor, just trying to be adequate enough to comfort and hopefully lead them in the right direction.

 

[NysEms2117]

That would be nice. Ive been trying to look for stuff on google but I don't know where to start. I am not trying to be a coucelor, just trying to be adequate enough to comfort and hopefully lead them in the right direction.

It'll be tomorrow, I'll see if I can get any Leo stuff on it, one of few applications I see ems and le can mix.

 

[Qulevrius]

That would be nice. Ive been trying to look for stuff on google but I don't know where to start. I am not trying to be a coucelor, just trying to be adequate enough to comfort and hopefully lead them in the right direction.

From my personal experience with psych patients, there's only so much you can do. We're not there to diagnose or treat them, we're there as their ride. The best thing you can do is to try and not aggravate their condition, although it's always a 50/50 random chance they'll flip. Reasoning with a true psych is borderline impossible, and the best way to deal with them is to keep your cool, behave evenly and not let them get under your skin (and they often will try, very hard). Long story short, keep it calm and professional, but always be on guard. And whatever they do or say, don't get dragged in.

 

[Underoath87]

Tip #1: never use the term "mental" where "Psychological" "psychiatric" or "behavioral" should be used. To do so is very dated and offensive.

 

[EpiEMS]

Because of my lack of experience, I usually feel useless and don't know how to approach these patients. I'm not talking about the obvious things like being nice and empathetic. Since they are mentally unstable, I assume I have to be really careful on what I say and how I approach them to keep the patient and myself safe.

I agree with this sentiment - I can't really do much other than be kind and call for law enforcement or ALS for sedation if required.

I've seen folks negotiate - offering a cigarette, etc. - but I'd like to see if there's anything better.

 

[NysEms2117]

A few things you could do...
1. Look to see if your agency/ county you live in will let you take a CIT class- Last time i checked it stood for Crisis intervention team, which deals with mental or psychiatric illness. I respectfully disagree with underoath87, I have had multiple parolees with a mental health illness/problem, and i actually asked them point blank does it offend you, and they said (while they were medicated properly) that it does not because they have said issue, and cannot deny that.
2. When it boils down to it, let them do what they want. I would be willing to wager a hefty penny that if they are giving you "that degree of trouble" there is a high percentage they have stopped their treatment plan. In my experience there really is nothing you can do, other then either A. wait until the situation dies down, or B. Do what Law enforcement sadly has to do(not saying that in a bad way, saying that because it's sad for another human to have to do this to another), and forcibly get them into a submissive state where they can be controlled.
3. In EMS the 3 things for you to try and do if you can is to 1. Turn off your lights if possible, they really help nobody if your responding to a house, if your on a road or highway then obviously protect yourself, but flashing lights help nobody if it is a "house call" 2. Find a family member, roommate, ect they have been living with said person and will more often then not stand a better chance on calming them down, 3. find their previous treatment plan, and ask the person(s) they live with if it was working! If it was working ask for them to write it down, or take the medicines with you, (If it was working why try and fix it, sometimes folks just decide not to take the medicine, does not mean it was not working)

**please do not yell, or comment at me for putting law enforcement articles, these are the FACTUAL articles that i have, and show how to interact. I do not encourage or support EMS providers in doing the Law Enforcement tactics in these articles, only the interaction techniques**

I encourage you to look at the table within the FBI's article.
http://www.asmfmh.org/resources/publications/tips-on-communicating-with-a-mentally-ill-person/
https://leb.fbi.gov/2014/february/r...-can-screening-checklists-aid-law-enforcement
http://www.popcenter.org/problems/mental_illness/print/

Let me know if you need clarification on any of these !

 

[EMDispatch]

Like Nys said, CIT classes are great and are one of the more advertised courses on these subjects. Though any sort of crisis communications type class or lecture will help a little bit.


Three quick ideas from training and experiences I've had. Granted these come from behind the desk, but I think we tend to get more training on the subject then field responders usually get.

1. You can't force them out of any beliefs they have. Saying something's in their mind, doesn't work and can backfire quite badly.

2. Using grounding statement or ideas works wonders. Something that bridges the gap between their perceived reality, and actual reality. It may be telling them where they are or talking about someone... It will be situational.

3. Have a calm demeanor, and use active listening skills.

 

[Fry14MN]

I'm a Security Officer at a large hopistal and we happen to have a very large mental health unit. Side note, I also agree with Nys, using the word "mental" is just fine unless used in a derogatory way.

Staying calm and comforting is what I try and do. Every patient is different and I don't think there is a blanket way to handle every patient. I base what I do on who I'm talking to and what they have going on. Stand off to the side of them, not directly on the side but not in front of them, that can come off confrontational. Assure and reassure that they are safe and you are there to help. I use the repeater method. I repeat back what they say to me so they know I'm listening. Unfortunately in some cases they become violent and then that's another level of training that would not apply. Bottom line, they're a person who needs help and it's our job to safely get them to the help they need and treat them with as must dignity and respect as possible while still maintains our safely and our partners.

Hope this helps. It's not from someone on the EMS side but I work with patients under this capacity on a daily basis

 

[phideux]

I've had Psych calls where we talked and laughed all the way in, others where we had a WWF cage match in the back, others where we flirted our way through the ride. Every situation is different, you'll learn how to "read" your patient and learn when to act or react, when to joke or stand firm. There's no 1 size fits all approach when dealing with psychs.

 

[VentMonkey]

There's no 1 size fits all approach when dealing with any patient.

 

[phideux]

OK, True, Any patient.

 

[dutemplar]

I'm going to do a modified Mattis on this one.

Be nice, be polite, but have a plan to knock unconscious and tie down everyone you meet.