What do you do with psych patients?

[BushyFromOz]

you don't?.......what did they teach you at uni in Bathurst? better still didn't you listen when you visited us?......cheers bushman

No man, i went around crash tackling 19 year old chicks at the bar

Iv'e never been the same since i met you craig

[craig]

No man, i went around crash tackling 19 year old chicks at the bar

Iv'e never been the same since i met you craig

Ahhhh the ultimate form of restraint...was it you crash tackling or their AVO's...........;D

[BushyFromOz]

Ahhhh the ultimate form of restraint...was it you crash tackling or their AVO's...........;D

i cant remember....

[Mateo_1387]

You know mateo, i wrote this nice reply to your long winded and at times completely of base rant, but i lost the post and really have lost my care factor to replying to you.

Ok, I admit I did go on a rant and was not very nice about presenting some of my thoughts. I also sincerely apologize for treating you in such a manner. You deserve more respect and I should have offered it. I hope we can move forward. I also hope we can continue the conversation, as I think it is an important topic.

But its quite clear the mental health patient your talking about and the violent non compus mentus psych im talking about are two different animals, so ill break it down to some dot points, i might even answer some of the questions you should have asked before you pulled your civil liberties speech on me.

The only patient I presented and wrote about is the example you used. I tried to make my discourse based on the ethics of restraints, but used your example to support my statements.

At no point did i say restraints are used in isolation as the only method of management

I never accused you of only using restraints. I did try to make the point that your liberal use of restraints ought to be restrained.  Based on your reply to Captain…

•

There is a reason why so much has to be documented in a hospital setting and many steps must be taken before restraints are put on. In EMS many providers use restraints as a crutch or a first resort rather than a last resort to deal with psych patients.

•

And i would be one of them

Any hint of aggression of violence in this acute presentation, even if it was before my arrical at scene for transport then they get restrained, and this includes interfacility transfers.

I will not put my self at risk of a patient returning to their former aggressive self when its just me and my partner driving down a freeway in a shoebox, they get soft restraints.

Patients here are scheduled i.e "committed" for transport to a mental health facility in the field. In order for this to happen they must have among other things, bizarre behaviour and thought process, lack of rational thought and be a danger to themselves or others. They are extreme cases to be committed do not have a right of refusal and they do not have the right for autonomy, so your attempted civil libertarian intellectual bitch slap has failed.

I understand there are times where involuntary commitment is necessary. No argument there. The right to autonomy is not lost though. Exercising the right may need to be restricted at times, though the goal should not be to maintain that restriction, but to restore the full use of those rights. Being able to be an active part of the treatments by being allowed to make decisions and choices would seem to be the better option than being on the sidelines without having any input. That is how we treat our animals when we carry them to the vet. It is not the way our mentally ill should be treated, if it can be helped.

The very fact they have lack of rational though and bizarre behaviour and violence makes it absoluetly appropriate, not required, appropriate for restraint

The very fact these patients are not capable of rational thought makes communciation strategies limited because, well, they are not capable of rational thought!

It could be that way. Just because there are some non-rational thoughts does not mean all thoughts are non-rational. It will be situation dependent.

Your smug comment is, quite frankly, horse crap. US providers, that is, people who work in the states routinely, almost daily, comment about the lack of underpinning knowledge in the EMTB curriculum. I didn't attack your system, i defended the guy from new jersey when a lack of knowledge comment was levelled at them. You cant expect the guy to know about the ins and outs of therapeutic communciation, legal, ethical and moral obligations when you freely admit the the level of education is flawed. I dont really care either way because im not in the states, but either its adequate or inadequate, you cant have it both ways to suit your argument here mateo.

Maybe I was harsh with the smug comment, but, from what I read scubanurse said to musiclife “Your wording in this also makes me concerned that you really lack the skills to deal with psych patients, the bolded statement in particular.” Then you come back and claim she assumes therapeutic communication always works, she says she didn’t. Then you come back and say she did and based your argument on a few points.

• One point being that she bashed a volley.

• Another saying “you don’t know how to communicate” comment

Neither of which happened. A concern was noted and then a suggestion made on her part.

Then you tried to say that since musiclife is an EMT-B therapeutic communication was not taught in his curriculum and that he is probably not the only one lacking knowledge and then blame it on the system. So yeah, way to protect the volley from New Jersey and take a jab at everyone else… You cannot have it both ways either sir…

Then you turn around and talk about willy nilly use of restraints. I quote from you “…so they get restrained or the don't travel with me "just in case". You restrain in the name of safety because you had a compliant patient bash your skull and abscond from the ambulance. It bothers me that you would cry on about his education then try and support your use of restraints on morally irrelevant previous patient contacts. I was not expecting this type of reasoning from an educated person. I digress…

And then there is this..... highlighted for your convenience

Perhaps you should tell me what is the most appropriate intervention for a paranoid schizophrenic, or any mental health patient who is scheduled, under the law i have described, which displays abnormal and bizarre behaviour, not competent of rational thought, who has already seen to be violent and aggressive without warning and is being forced into care as they no longer have the capacity for rational autonomous thought and therefore have no right of refusal, tell me again, if soft restraints is not part of appropriate management, what the most appropriate treatment should be?

What do you think i do, walk around crash tackling 16 year old depressed kids to the ground who are having had a bad day, give them 10mg of midazolam, then strap them to the stretcher prone, with a spine board on their back?

Off my soap box, i suggest you get off yours too.

Now you are just reaching. Restraints may be necessary in the course of treatment, which has never been the argument. I am fairly certain you do not treat patients as you described above (ref. 16 y/o depressed kids). I will though try and answer your scenario question. The patient you describe could be an Autism patient, mental health patient, not competent, prone to violent and aggressive behavior and everything else you said. Maybe letting their family member ride to help keep the patient calm rather than restraining them could be a more appropriate treatment. Maybe talking to the caretaker about how to best handle the patient would be beneficial in altering how you approach the patient. How about using techniques the patient may have employed in the home like using music to keep the patient calm. These are a few examples. It may come to a point where physical or chemical restraint may be necessary, but if you jump to that first thing, I do not see the good that would come from it.

Your posts have been riddled with your continuing support of restraints as a first resort, lacking impartiality, and based off of morally irrelevant information. You give me hell about trying to preserve civil liberties and ranting, but your views are not necessarily correct. That is why I offered my own take on the subject. I am not going to attempt anymore inflammatory remarks. It is not my ultimate goal. On the other hand I am not going to stand down for something I truly think you are wrong about until its proven otherwise.

[BushyFromOz]

You do realise i am not working in the united states yeah??? I am very annoyed you made this about my supposed lack of morals, apparently this is reasonably deduced from 3 posts on an internet forum.

When i read our conversation, i cant help but feel we are talking about 2 different patients and situations. I know what im trying to say but cant seem to get it across, i can picture it in my minds eye the situtations in which i have restrained people as a crutch of first resort, but when i read your reply i cant see in it what i was trying to show you? I guess my last defence i have is that in neasrly 6 years of ambulance i have applied restraints maybe 5 times.

Perhaps my threshold for what constitutes a "hint" of violence is higher than yours? I dont know.....

Based on this I can already see we are doomed to spin in circles saying he said she said, and i can argue against anything you have posted, but for the sake of avoiding an argument that neither will give in on, i am going to drop it

Have a good day

Edited July 20, 2013 by BushyFromOz

[Mateo_1387]

I know you are not in the United States. I've known that. Nothing new. But look, I never meant to convey you lack morals, I just thought your views on this subject were lacking in them. That make sense? I thought my counterpoints explained that, maybe I failed in that respect... I can only take what I read on here and go with that, unfortunately I do not know you on a personal level where I may have a better understanding of what you post. So much is lost in text alone when having conversations and at times I do miss the finer points of expression via text, it is a downfall of mine.

Maybe we are talking about two different patients. I've only applied physical restraints once myself and chemically restrained a slew of other patients. Its just not something I take lightly, which I thought you did. Anyways, my idea of a patient possibly needing a restraint procedure is usually the patient I meet where within the first minutes of arriving on the scene we are already in a physical situation that is not deescalated by other means. I took your examples to be the patients that hint at violence, had a previous episode of abnormal/violent behavior, and the like. I guess for me I tend to try and treat on the current situation and have yet to have a patient "turn". This may be the point where we are not seeing eye to eye, different experiences... different thinking process...

Anyways, try not to take it too personally, please. I've had my thoughts and viewed slammed on here more than once and I think I'm better since most of it. Hope this helps to ease tension and improve understanding.

G'day

[BushyFromOz]

Im cool with it

[dananeal]

I would too advice to call Psych clinic yourself for advice. It helps to differentiate between an episode of a mental illness, which is not going away, and a transient reaction to a relationship blowup, which goes away.

[Just Plain Ruff]

I would too advice to call Psych clinic yourself for advice. It helps to differentiate between an episode of a mental illness, which is not going away, and a transient reaction to a relationship blowup, which goes away.

Did you even read this thread?

What exactly are you commenting on?

Edited August 8, 2013 by Captain ToHellWithItAll

[dananeal]

You concern is really valid. The psych patients who are in need of emergency help have to travel for long distance. It seems that there are no proper policies and guidelines that can govern the health issue around your regional area. I think the administration should look into the cause. Best of luck for your good work to society!