What do you do with psych patients?

[medicgirl05]

In my area we have no inpatient psych facilities. The closest one is about 100 miles away. As a result of this we have repeat patients with underlying problems that aren't being evaluated. I am at a loss for how to help these patients.

One example is one particular patient repeatedly tried to harm himself as a result of a known psych disorder. We would transport this patient sometimes twice a week to an ER and then after being treated for the immediate life threat was sent home to try again.

Law enforcement can get an emergency committal but it usually takes about an hour to get the paper signed by a judge, and the paper must be complete before the patient is under a physician's care otherwise it won't work. The issue with that is that in most of these circumstances sitting on scene with the patient that long is unrealistic. After they get to the ER it doesn't matter what we tell the ER doc, as long as the patient says they don't intend to hurt themselves or others they don't get a psych hold.

I'm curious if other agencies are having this problem, and if so what is being done?

[Happiness]

Welcome to the mental health system..................Not much you can do on your own its a system thing. I hate having to deal the phyc things in my community as I know that with in a few hrs of being admitted into the hospital they will be on their way,

[Arctickat]

Call the attending at the psych clinic yourself for advice. Tell the doc what you're dealing with and if he'd be willing to consult the next time you have this patient. If the psych doc is willing to accept the patient, then transport him to the psych centre next time and bypass the local ER.

[medicgirl05]

We can't bypass local facilities. The psych places are out of our transport range unfortunately.

[Bieber]

Sounds like you need to change your protocols, then. Do you at least have sedatives/antipsychotics available to you by standing order to use if you need to?

It sounds like the system isn't working in your area. Protocols, policies and guidelines are meant to make the system work efficiently and effectively; if they're no longer doing that (or haven't ever done that) then it's time to get management involved. How else can you provide the kind of care this patient needs?

[medicgirl05]

No, unfortunately we don't have protocols to help with these patients. I have spent years trying to find a solution but I am not exactly in a position to really DO anything.

Is this a problem that other services have?

[Arctickat]

We can't bypass local facilities. The psych places are out of our transport range unfortunately.

Who says you can't? You are supposed to transport the client to the nearest appropriate medical facility, are you not? If this is a psych issue and the doc agrees, then just take him there. Sure, your company might get some heat for it from the local medical staff, but they aren't psychologists now are they? So long as you document, document, and get the psych doc to sign off on the arrangement, you're golden.

[mobey]

Along the same lines as Arcticats suggestion, you should write up a formal letter to your medical director to plead your case.

[island emt]

psych beds are getting hard to find. One of out two regional hospitals actually has a secure ward with a dozen beds, and two secure rooms in ER. Problem is those bed are almost always full and they may have to ship a PT. 7 hours north to find an open bed in an appropriate facility. Juveniles are even harder to find placement for.

edit for spelling

Edited December 31, 2012 by island emt

[medicgirl05]

Who says you can't? You are supposed to transport the client to the nearest appropriate medical facility, are you not? If this is a psych issue and the doc agrees, then just take him there. Sure, your company might get some heat for it from the local medical staff, but they aren't psychologists now are they? So long as you document, document, and get the psych doc to sign off on the arrangement, you're golden.

There's no way we can go that far. We don't have the resources to keep a truck out of service that long. I guess it might be a nice thought but it is unrealistic.

I have spoken with our medical director numerous times but the outcome is usually that long term psych care is not my concern. I'm supposed to treat the lifelthreatening emergency but that's the end of my responsibility according to my superiors.