tag:blogger.com,1999:blog-26666124.post3957403210814855729..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: Send Them AwayUnknownnoreply@blogger.comBlogger21125tag:blogger.com,1999:blog-26666124.post-30280129902006000142012-02-20T05:49:31.990-05:002012-02-20T05:49:31.990-05:00I haven't read the vignettes yet, so I figured...I haven't read the vignettes yet, so I figured I'd play.<br /><br />A - 72 hour hold, see if social worker can get him hooked up with community mental health.<br /><br />B - If there's a hospital with a substance abuse ward, great. Should detox under medical supervision. If not, send to jail ("drunk tank") and evaluate in the morning.<br /><br />C - Versed, send to jail, evaluate in the morning.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-78429478562334536982012-02-18T09:40:14.535-05:002012-02-18T09:40:14.535-05:00I almost agree to Liz and Jesse, for both sound pe...I almost agree to Liz and Jesse, for both sound perfectly fine. But I think that even as a clinical scenario it is best to pass a judgment when we have just one case in hand at a time, and things can always change with more information coming in. With three cases being considered together it can be just a guess, nothing more than that. And its always different in a real situation. However, it is best in each case to have more information before reaching at any conclusion.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-34543672623703269412012-02-17T20:04:39.845-05:002012-02-17T20:04:39.845-05:00Keep A at least until you can see if he responds t...Keep A at least until you can see if he responds to same treatment. Send B to ED. C.....keep for a few hours, if no improvement, to ED for at least labs.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-90856372649146040102012-02-16T22:06:07.414-05:002012-02-16T22:06:07.414-05:00Anon: Yes, in most cases the jail psychiatrist doe...Anon: Yes, in most cases the jail psychiatrist doesn't know the details of what their patient has done (or accused of). They know the charge, but not specifics. In usual circumstances the police drop the defendant at the booking station, fill out the charging papers and leave. They are gone before the person is seen by a mental health professional. This is particularly true in large urban jails where literally hundreds of people may be brought in over a 24 hour period.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-22136154158044490842012-02-16T12:31:54.771-05:002012-02-16T12:31:54.771-05:00"Anon: Patient C was under arrest, which mean..."Anon: Patient C was under arrest, which meant police were planning to charge him once he quit fighting. We don't know the details of why he was brought in."<br /><br />I cannot understand how it is that the forensic psychiatrist would not be given the information about what led to the arrest. The police brought him in. He didn't appear by magic. I was brought to a hospital by police. They dumped me there but not before giving the staff a summary of why, in their opinion, they had been called to attend the scene. Hospital still had to figure out if I was psychotic or strung out on drugs. Hint: it wasn't drugs.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-39010363345004433742012-02-16T06:11:49.996-05:002012-02-16T06:11:49.996-05:00Rob: It's a little hard to ask these three pat...Rob: It's a little hard to ask these three patients about their longterm aspirations. Maybe after they're done being tormented by demons or wrestling with police.<br /><br />Anon: Patient C was under arrest, which meant police were planning to charge him once he quit fighting. We don't know the details of why he was brought in.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-22421860636998141492012-02-15T08:22:13.391-05:002012-02-15T08:22:13.391-05:00So Patient C is agitated, covered in blood, but un...So Patient C is agitated, covered in blood, but unlike patients A and B, it is not apparent that he was brought in on any charges so why did the cops bring him to a jail rather than a hospital? He may or may not have a record but did he commit a crime or offense? Take him to a hospital. Of course, people who are charged with something may still need treatment but this guy is in the wrong place.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-50201360589871850582012-02-15T08:09:42.760-05:002012-02-15T08:09:42.760-05:00"People with mental illness require the right..."People with mental illness require the right treatment, at the right time...." if they want it.<br /><br />In MY opinion, you spend too much time complaining about stigmatization of the mentally ill, and not enough time considering what mentally ill people want. <br /><br />wv = redisc. The CD the manufacturer mails you when you lose the original (that you were supposed to keep safe in a drawer somewhere)rob lindemanhttp://natickpediatrics.netnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-52558747596164235432012-02-15T06:14:33.660-05:002012-02-15T06:14:33.660-05:00Oh, I forgot to mention: the only phone in the boo...Oh, I forgot to mention: the only phone in the booking area isn't working. And you have no fax machine.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-50090982458430065072012-02-15T06:13:31.487-05:002012-02-15T06:13:31.487-05:00Liz wants to know if there is a safe place in the ...Liz wants to know if there is a safe place in the jail to monitor people. The jail does have a psychiatric infirmary with an observation cell, but since these people haven't been booked yet you can't send them there. There is a cell in the booking area that is sometimes used to house people by themselves, until they can get booked and charged. These are not observation cells though, officially. That may influence your decision to keep all three patients. <br /><br />Rubin would like to send out A and B, but would definitely keep C.<br /><br />Jesse took an unexpected (to me) approach and suggested that Patient A is delusional about hurting his mother. (He's not, the police found her. Patient A's mother was just not known to the facility---with emphasis on the past tense.) He would send out B and keep C.<br /><br />Spritz would keep A, send out B, and place C in a restraint chair. Ah, if only the jail had one of those! No, the booking area only has an unofficial isolation cell. And be sure to get some medicine into C before he goes into that cell because custody will not touch him again after that until he calms down. Unfortunately, C came in on the night shift and the duty lieutenant will refuse any request for show-of-force assistance when giving medication (even though the policy says they're supposed to help).<br /><br />The two anonymi are falling in with the pack to keep A and C but send out B.<br /><br />Great responses, everybody! I'm going to let this post ride for a bit to see if some of our more shy readers will come out and put up some thoughts. I've also got a Twitter buddy in the UK, @mentalhealthcop (good guy to follow!) I'm hoping will chime in with his experiences. Then I'll post the ending to all these stories. I'm glad people enjoyed my characters enough to fill in the back story!<br /><br />MM: Most mentally ill people who become insanity acquittees are only violent as a last resort. It can happen, unfortunately, but it's not the norm.ClinkShrinkhttps://www.blogger.com/profile/13316134491751195651noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-42918368615872336542012-02-15T05:28:24.392-05:002012-02-15T05:28:24.392-05:00Patient B needs to go to the hospital. He is exper...Patient B needs to go to the hospital. He is experiencing DT's from his abuse. He could go into seizures, and have high blood presure from such.<br />Patient A has a mental disorder possiabl from drug use, but is ok on meds. He needs a few more hours to come off any drugs, closly monitored in jail and recommened for on going counseling when appearing in court.<br />Patient C needs to be in jail for behavior disorders and neds to ahev some consequences for such.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-73399641627328135762012-02-15T01:11:17.340-05:002012-02-15T01:11:17.340-05:00You know if you treat A he will come around to san...You know if you treat A he will come around to sanity and he trusts you so he's better off staying at the jail. B is more of an unknown and has a head gash that should be treated so he should go to the ER. C needs to calm down for awhile. You can't send someone that violent to the ER.Anon Anonnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-54515411173681900492012-02-15T00:52:56.147-05:002012-02-15T00:52:56.147-05:00I have trouble believing that mental illness alone...I have trouble believing that mental illness alone can cause violence. I have been pretty seriously mentally ill and I have known others who have been pretty crazy, but although there has been a lot of violence in my life none has been committed by a mentally ill person. In fact a lot of the people I know became mentally ill from being raped, while their attackers would be considered sane.MMnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-73579614710653811372012-02-15T00:50:14.537-05:002012-02-15T00:50:14.537-05:00Easy. Patients A, B, and C are brothers. A was usi...Easy. Patients A, B, and C are brothers. A was using what was in his begging cup to purchase a 40 oz at the local market. B works the register there. A call from B's controlling mother interrupts and derails their conversation. B says he was left at a mini mall by his mother when he was 8 years old. Strangely enough, B remembers having a brother who his mother lost at at that very same mini mall. B invites A over to meet his long lost mother and other brother. At the mother's home A and B are discussing angels and demons. Mommy Dearest butts in and claims that C is a demon. C gets enraged and goes after Mom with a knife. A(with no violent history) tries to save Mom by fighting C for the knife, accidently stabbing Mom in the throat. B gets in the way, causing his head to be gashed by the knife. B forces A to kiss the owie better because his Mom can no longer do it. C becomes violent because his mother was not killed by his own hand. <br />A gets a chic safety smock.<br />B gets an ER transport for that expensive new battle wound.<br />C gets a restraint chair and some quiet time with happy thought.<br /><br />But on a more serious note, this is why all states should require CIT courses for their certification of peace officers. I am glad we do not operate that way here.Spritzhttps://www.blogger.com/profile/17864742979110401041noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-38426483672820777022012-02-14T21:14:51.989-05:002012-02-14T21:14:51.989-05:00Jesse,
A's mother showed up after a 30 year ab...Jesse,<br />A's mother showed up after a 30 year absence and he he shot her in the head. Or, A never talked about his mother so she was not known to anyone but he has had her tied up in the cellar for 15 years.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-89745043481812453112012-02-14T21:14:37.676-05:002012-02-14T21:14:37.676-05:00Jesse,
A's mother showed up after a 30 year ab...Jesse,<br />A's mother showed up after a 30 year absence and he he shot her in the head. Or, A never talked about his mother so she was not known to anyone but he has had her tied up in the cellar for 15 years.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-74935593599474108542012-02-14T14:12:05.188-05:002012-02-14T14:12:05.188-05:00OK, I'll take a shot at this. You know A and h...OK, I'll take a shot at this. You know A and he trusts you. No medical history that would warrant an ER. No family so what he said he did to his mother, he did not. Keep him and check in every so often. B has a gash and perhaps an internal bleed, who knows. Send him to the ER. C, watch him, but not from too close or he'll bash your head.jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-946364378407801562012-02-14T12:25:10.046-05:002012-02-14T12:25:10.046-05:00Psych resident here. I agree with Liz. This is a...Psych resident here. I agree with Liz. This is a very difficult situation. I would attempt the history (including collateral information) and physical with patients A and B. My gut reaction is to have both sent to the ER for basic labs due to the concern of intoxication but the risks of them falling through the cracks is another issue. Patient C would be monitored and assessment attempted once he has de-escalated.Rubinhttps://www.blogger.com/profile/11827741211545514507noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-63441426066666785022012-02-14T11:14:44.970-05:002012-02-14T11:14:44.970-05:00Due to budget cuts, the only ones who get psychiat...Due to budget cuts, the only ones who get psychiatric care are the people who don't really need it., those who can see an outpatient shrink. Emergency psych treatment is an oxymoron where i am so it is not clear that someone charged with a crime would be any better in a hospital where everyone is ignored and drugged to the point that their angels and demons shut up, though they could still commit suicide on the ward and no one would know for hours. To be clear, this is not anti shrink, it is anti the system.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-34418640693402692962012-02-14T08:52:26.302-05:002012-02-14T08:52:26.302-05:00Happy Valentine's Day, to you too! I woke up,...Happy Valentine's Day, to you too! I woke up, saw this on my email, and it was like one of those dreams where you never get out of school. Especially with the "Please Discuss" requirement. Oh my.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-78661143917755028772012-02-14T08:39:56.649-05:002012-02-14T08:39:56.649-05:00point taken-- clink. i have no idea which patient...point taken-- clink. i have no idea which patients i would keep and which i would send for further treatment. <br /><br />do i have a safe place to keep them at the jail where they can be monitored closely and carefully? could i keep them and have them be carefully monitored, and then, if their agitation continues to grow, have them evaluated at that point?<br /><br />patients a and b: <br /><br />i'd perform a physical and interview them to determine the reasons (in their understanding) they were brought to jail as well as preceding events. i'd also want to read the paperwork and speak with the arresting officer to enhance my understanding of the situation. <br /><br />i'd re-evaluate my decision after i completed those tasks. i'm particularly wondering the age of patient b... if he's manic and whether he's been treated before. <br /><br />patient c: de-escalation would be a nice first goal... is he aggressive when left alone in a room? does this agitate him or calm him down? i'd try letting him sit in a room, closely monitored. while he's calming, i'd try to do all possible information gathering... after he's calm and able to interact, i'd interview him and determine next steps.<br /><br />you win, clink. i have no freaking idea, really, what i'd do beyond keep them safe and try to figure out what the heck is going on with them.Lizhttps://www.blogger.com/profile/18354453322985313284noreply@blogger.com