Is a Mental Health the hardest call to attend?

[aussiephil]

When i peruse the forums i see al lot of posts on the usual stuff like trauma, chest pain, etc. These are reat & good to stimulate the mind, however, for the most they are no brainers. So, i thought it would be interesting to see how challenging others find mental health patients & cases to deal with.

Currently in Australia we are going throught the worst drought in 100 years & this has lead to an increase in the number of severe mental health issues.

While a majority are dealt with by local Doctors traditionally ambulances & pre-hiospital care providors see these patients at their most extreme.

My questions are:-

With the number of diagnosed mental health illnesses, personality disorders etc, how do we know how to diagnose these patients?

What is the most effective way to treat these patients?

Lastly, how well do you believe you are trained to cope with & adquatle provide pre hospital care to mental health patients in your area? :twisted:

Phil

[AZCEP]

For most it will be supportive care only. Diagnosing the problem is a challenge, but appropriately treating said problem would be near impossible. The resources that are allowed in prehospital care just don't make much allowance for these patients.

[JPINFV]

With the number of diagnosed mental health illnesses, personality disorders etc, how do we know how to diagnose these patients?

I don't think we can "diagnose" a lot of these patients. There's enough controversy in psychiatry already about some of the illnesses and how to diagnose. How can we be expected to differentiate between bipolar, schizoaffective, schizophrenia, etc including all of the subtypes. Is the patient manic or hypomanic (difference between bipolar 1 and 2)? Is this patient suffering from schizoaffective disorder: Bipolar type, or schizophrenia? In my research group, every patient has to see a doctor before testing, even if we've tested them before. They might have been diagnosed with one disease the last time we've seen them and now a few months later be diagnosed with something else.

What is the most effective way to treat these patients?

I don't think that there is no one way to treat psych patients. I have as much disdain for the "every psych patient gets restraints" method of treatment as for the "every patient gets O2" method of treatment. Restraints should be an option, but not an automatic. Just because they have a medical problem doesn't mean they lose all of their rights, even if they lose some (patients on holds, for example).

I believe that basic education does a great disservice by not requiring clinicals in psych units and not really teaching the differences between the diseases. My EMT book covered psych illnesses in less then a page. There is a point where the medical provider has to move from being friendly and passive to being in control. Example: Psych transport from a local ER to a dedicated psych hospital. The patient (17 y/o male), diagnosed with schizoaffective disease is being accompanied by his mother. Personally, I don't mind family members riding in back with the patient most of the time (there are exceptions, though). The patient started changing from an apathetic mood to a more depressive mood with some hints of rage. The mother basically told him, in not so many words, to calm down and shut up. The kid calmed down.

Lastly, how well do you believe you are trained to cope with & adquatle provide pre hospital care to mental health patients in your area? :twisted:

Phil

see above...

[mediccjh]

So if someone with multiple-personality disorder wants to RMA, do you have them sign one refusal, or one for each personality? And what if only one of the personalities wants to go the hospital, and the others don't? Can you be charged with kidnapping?

[Ridryder 911]

One of the reason the psychiatric calls is demanding and difficult as well is multi reason. One the EMS provider is not properly trained and educated properly in psychiatric emergencies, one chapter or few pages in not near enough to even touch the tip of the iceberg of mental health disorders. Did you perform mental health scenario and how many clinicals did you attend during EMS training?

The second part.. we cannot see or pinpoint mental health problems. There is no "physical" illness to correct or see an immediate result in change from treatment. Mental illness is really is a chronic illness in regards that most of the patients will have to be treated forever.

R/r 911

[aussiephil]

I agree completly Rid, &i really do believe that Mental Health is really the thing we, pre hospital do worst.

Education will go a long way & in 3 years in EMS i have had a total of 3 hours trainin on mental health & that was all touchy feely. Not what it is like in reality.

Having said that, what suggestions could be made to improve the per hospital delivery of mental health services around the globe?

[itku2er]

I agree with RIDRIDER on this one..The mind is a strange thing makes people do strange and unusual things. But we as EMS people are just trained to handle the emergency that they are having. These people need more help than we are trained at doing. We should just treat them with the compassion we do all the others and let the professionals deal with their deeper issues.

[emtpsaveu911]

obviously we need more education, as for the solution for now well um the hospital i work in, when we get psych pts in ER ( we don't have psych services in house) so we call whats called comp services or social services. They have a person an call 24 hours to go out and talk with the patient who is in need of mental health care and then place them as needed in appropriate facility. I'm not sure if it would be prudent for us to call them to the scene on certain cases or not. Or maybe take it out of our hands all together and let the 911 center deal with that decision if they get a mental health call they automatically place a call into the social services to respond with ambo and police,, or maybe thats just way tooo much! over thinking :wink:

My husband has his masters in social work in mental health--He is actually a counselor for a community resource center--I'll see if he has an opinion either way.

[strippel]

I don't think mental health patients are difficult to deal with. As Rid stated, supportive care is the way to go.

First, ensure your safety, your crew, bystanders, and the patient.

After that, it is professionalism and respect. Ask appropriate questions, do an assessment.

Most mental health patients have legitimate medical problems. They need inpatient/outpatient, and pharmacological treatment from MDs, psychiatrists, psychologists, and social workers.

If they are anxious, reassure and calm. If they are depressed, talk to them if they are willing.

There are those that are just nuts, or criminal. Be careful with them.

The patient needs a specialist, EMS is there for the ride.

I am glad our 3 local hospitals are very supportive of mental health patients, especially in the emergency setting. There is another hospital nearby where the preferred treatment of involuntaries usually consists of 4 point restraints in the emergency room.

[MeekoBB]

Same as everyone else...

I try not to play into the pt's delusions, however, there are times you must...

Recently a crew had a paranoid schizophrenic (had been diagnosed by DR), and thought everyone and their mother was after them...Crew tried assuring the pt but their attempts initially failed and played into their story a little bit telling the pt that they were taking them to a secret witness protection office that is located in the hospital that only EMS knows of in case of special circumstances like that pt's.... They had no problem the rest of the trip.

That same hospital uses 4 pt restraints only when a pt is combative.

Its difficult to deal with psychs. I had to transport a discharged soldier who was suffering from PTSD after returning from overseas. He was telling us stories about what he saw and dealt with there and I just couldn't find any words to console him.

It is a shaky topic psych pts.