Sunday, November 11, 2007

Mental Health

My bipolar schizophrenic frequent flyer is back. It's been 6 months of stability, so she quit taking her medications. Last week she started coming into the ER 5 or 6 times a day requesting to be seen for problems such as "I need my pill box filled," "I have a sore on my toe," "I need a shower," and "I need something to eat." She refuses mental health services and the system deems she is still competent to make her own decisions.

These types of patients are so hard to deal with. It is not their fault they behave like they do. They don't really have control over it. Yet I still get angry when she has interrupted my care on a much sicker patient for the 4th or 5th time to request something simple. The sad thing is that one day she will come in and truly be in a crisis and nobody will believe her.

She has learned not to come in when I am working now. I don't give her anything she wants. She gets her MSE and then I discharge her immediately. By the end of last week she started calling first and asking if I was working. If I was, she stayed away. I like that little arrangement.

Eventually one of her neighbors will call her daughter and she will come up and start making her take her medicine again. She'll stay on her meds for about 6 months and then we'll start all over.

Our state has cut many of the services for the mentally ill. This means more untreated patients clogging up the medical side of the system for mental health needs. It's a vicious cycle, and it is extremely frustrating to deal with on a daily basis in the ER. I don't have any answers for it, other than increase funding again. I hate politics - I usually don't get involved in political arguments or discussions at all. But this issue is really starting to irritate me. Another contributing factor to ER over crowding.


The T-Dude said...

And in Mass. the advocates for the mentally ill are trying to get standards passed for how the mentally ill get treated in EDs. Restraints, whether or not they have to strip, etc. ED's are not the place for the mentally ill, they need to have the safety net returned to them

L.B. said...

I can tell you from my own experience with an ill family member, it is so hard to get help that sometimes the ER is the only choice. The system is a mess.