Emergency Responses for Psychiatric Patients in Crisis

Regarding psychiatric patients?

I understand that patients are only forcibly taken to the hospital if they are self-harming or pose a risk to others.
However, what if a patient experiences an episode where they run outside without clothes, or post notes on community bulletin boards describing their delusions, suddenly yelling and causing a scene? They might ask questions that are incomprehensible or nonsensical, and they may have a knife but are unsure if they would actually harm someone.
In such situations, if an ambulance is called, what would the response be? Would they take the patient to the hospital for observation, or would they simply try to calm them down? If they only provide reassurance, I worry that the patient's condition at home could worsen, and I am uncertain about what actions they might take.
They might feel that we consider them insane, yet they do not self-harm or pose a danger to others, but their behavior is still intolerable.
Would calling an ambulance be effective in this case?
I have seen many reports or articles stating that when family members call for an ambulance, the patient is taken to the hospital for observation, even if they are not exhibiting violent behavior.
If they are indeed taken to the hospital for observation, I have heard that it lasts only about two weeks, which seems too short, and they might be sent back before receiving adequate treatment.
What should be done afterward? Should we contact the hospital? I am also concerned that if they are sent back home, their condition might worsen.
I live in Pingtung and have consulted at Pingtung Hospital, but it felt like a routine visit for a common illness, and my questions were left unanswered.
They only mentioned that if hospitalization is needed, we should reach out to them again.
Should I seek consultation at another department in the hospital?

Xiao Gou, 20~29 year old female. Ask Date: 2007/11/30

Dr. Zhang Zhehong reply Psychiatry

Hello, sometimes when doctors have a high volume of patients, they may not be able to discuss all issues in detail.
Each patient has unique considerations, and there is no single solution to your concerns.
The most important approach is a multimodal treatment plan that includes medication, psychological support, and occupational therapy.
Larger hospitals typically have more social workers who should be able to address these questions.
The healthcare team should be able to collaborate with you, and I hope you successfully receive the assistance you need.

Reply Date: 2007/11/30

More Info

When dealing with psychiatric emergencies, it is crucial to understand the appropriate responses and interventions that can help stabilize the situation. In the case of a patient exhibiting severe symptoms, such as disrobing in public, shouting incoherently, or displaying erratic behavior, it is essential to assess the risk of harm to themselves or others. While it is true that emergency medical services (EMS) often intervene when there is an imminent risk of self-harm or harm to others, the presence of severe psychiatric symptoms alone can warrant a call for help.

Emergency Response Protocols
1. Calling Emergency Services: If a patient is in crisis, showing signs of severe agitation, or behaving in a way that poses a risk to themselves or others, calling for emergency medical services is appropriate. EMS personnel are trained to handle psychiatric emergencies and can provide immediate assistance. They will assess the situation upon arrival and determine the best course of action.

2. Assessment and Stabilization: Upon arrival, EMS will evaluate the patient's mental state, level of agitation, and any potential risks. If the patient is deemed a danger to themselves or others, they may be transported to a hospital for further evaluation and treatment. In cases where the patient is not an immediate threat but still requires assistance, EMS may provide calming techniques or medications to stabilize the situation on-site.

3. Transport to a Psychiatric Facility: If the situation necessitates hospitalization, the patient may be taken to a psychiatric unit for observation and treatment. The duration of stay can vary based on the patient's needs, but it typically involves an initial assessment period. While two weeks may seem short, it is often sufficient for stabilization and the initiation of treatment plans.

Post-Emergency Follow-Up
After the patient is stabilized and discharged from the hospital, it is crucial to establish a follow-up plan. This may include:
- Regular Psychiatric Care: Schedule follow-up appointments with a psychiatrist or mental health professional to monitor the patient’s condition and adjust treatment as necessary. This ongoing care is vital to prevent relapse and manage symptoms effectively.

- Therapeutic Support: Encourage the patient to engage in therapy, which can provide coping strategies and emotional support. Cognitive-behavioral therapy (CBT) and other therapeutic modalities can be beneficial in addressing underlying issues.

- Family Support and Education: Family members should be educated about the patient's condition and how to provide support. Understanding the symptoms and triggers can help family members respond appropriately during crises.

- Crisis Plan: Develop a crisis plan that outlines steps to take if the patient begins to exhibit concerning behaviors again. This plan should include emergency contacts, preferred hospitals, and specific interventions that have been effective in the past.

Addressing Concerns About Hospitalization
It is natural to worry about the potential for worsening symptoms after a hospital stay. However, it is essential to view hospitalization as a part of the treatment process rather than a definitive solution. The goal is to stabilize the patient and provide them with the tools they need to manage their condition effectively. Continuous communication with healthcare providers and active involvement in the treatment plan can help alleviate concerns and ensure that the patient receives comprehensive care.

Conclusion
In summary, if you find yourself in a situation where a loved one is exhibiting severe psychiatric symptoms, do not hesitate to call emergency services. They are equipped to handle such crises and can provide the necessary support. Following hospitalization, ensure that a solid follow-up plan is in place to support the patient’s ongoing recovery. Remember, mental health is a journey, and with the right support and treatment, individuals can lead fulfilling lives.

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