Should mental health nursing be grouped with addictions nursing?

  1. In our mental health facility in our hospital, the addiction/recovery/substance abuse patients are in the same milieu as those diagnosed with schizophrenia/bipolar/depression/etc. My question is, although the symptoms are the same (and often times mental illness led to substance abuse and vice versa), should the patients be treated the same, and grouped together in discussions??
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  2. 17 Comments

  3. by   gzussu
    Absolutely not. So many times we will have a sudden influx of substance abusers who end up turning the unit into a jail house type of environment. The true psych patients will start to decomp because of this negative atmosphere. They are sometimes bullied by the substance abusers. Psych patients are quiet. The unit is quiet. But once these guys and gals come in the milieu is loud and chaotic. The SAs are so demanding and needy that the psych patients are kinda inadvertently put on the back burner. Many psych patients will begin isolate or go back to isolating. It's not fair to them. I hate working with SAs. I can think three SAs who I actually cared about because they showed true will to change. The rest of them I couldn't care less what happens to them. They are generally, from my exp, ungrateful, needy, selfish, and just aholes. They plot and scheme. They gang up on staff. I feel So bad for the psych pts. All of a sudden the isolative and non verbal pts become the model pt and of course we don't want pts to be non verbal or isolative. I don't even consider my floor a psych floor. Of course this is my exp. But I can't imagine that I'm the only one who feels this way.
  4. by   tom7044
    Absolutely not is the only correct way to answer this question. Addictions Nursing is a speciality unto itself. This is established by the International Society of Addictions Nusing and Addictions Certification Board. You need some basic psych nursing skills as you do in any area. Sound medical surgical skills are essential and specialized addictions nursing courses. You need to know some of the basic neurological concepts. Basically, you need experience in addictions and you can get that experience by finding a job where the staff is willing to train and mentor nurses new to this specialized are
  5. by   DharmaLynn
    I feel quite differently about this. So many of our clients are dual diagnosed. So often when the families want a place to help their mentally ill family member...this is where they get them admitted. They don't get admitted detox...being placed right into the residential areas. Nursing staff often works closely with their Social worker when their is a concern. If they are disruptive to other's therapy...we try for a transfer or an IOP. The recovery process tends to bring the issues/behaviors of their mental illness to the forefront once they can no longer mask it by SA. Our facility chose SWs that were strong in both specialties....as they did with their nursing staff. That's just how my experience has brought me to feel, I value what people that feel differently have shared.
  6. by   Saiderap
    I do agree that that bullies and withdrawn mentally ill patients should be separated. I think though that substance abusers can also be withdrawn and mentally ill and mentally ill patients can be abusive. Substance abusers end up on the mental ward because of their self-abuse where they might be subject to bullying. Someone should be trained in both areas and know they overlap.
  7. by   iwanna
    I often wondered if there was an addict that did not have an underlying mental illness diagnosis. I suspect that all addicts have substance abuse/addiction as a secondary issue. I believe the majority of addicts have dual diagnosis. One hospital rehab that I worked at, would get transfers from the psych ward, once they were stabilized there.

    I agree with Saiderap. It is not a one size fits all. You will have SA that are quiet, withdrawn, depressed, and you can have other patients that are abusive. There will always be some type of mix, including MR patients. Some are disruptive and can be physically abusive. And, you will have axis II patients. In an acute hospitalization, it is difficult to separate them.
  8. by   SmithRNclassof97
    I don't think the treatment should be the same, but I don't feel psych and addictions patient should be kept completely separate. We have so many people with co-occurring disorders out there. How can you isolate one from the other? I know that addictions is a specialty in itself and so is psych, but the patients so frequently have both problems going on. We as professionals should be educating ourselves in the areas we don't know or understand. I have been in psych for 12 years: 2 years inpatient and 10 in the community. I am finally taking my certification exam in 6 weeks. I got my BSN (a long time ago) but I am currently in the process of getting an AD as a drug and alcohol recovery councilor and eventually going for psych NP.
  9. by   Tom RN, NRC
    First I'd suggest that we look at our language. Referring to individuals by their diagnosis perpetuates forms of othering such as stereotyping, stigmatizing, discrimination. This type of depersonalizing is usually a symptom of a systemic issue, so I won't point out anyone in particular. That said we should not let under staffing, lack of educational opportunities, and inadequate working space turn us against the persons we care for. That said I have felt the frustration myself and have had to provide care that left me feeling burnt-out, inadequate, and angry. It sucks.

    Separation of client based on diagnosis is typical practice and makes sense in many cases. For example detox. There are acute clients on a detox who need specific assessments and intervention that would not apply to most other clients. Another example might be an acute psychiatry where again specific assessments and interventions tend to take place. The problem of course is that a ever growing portion of our clients are dual diagnosis, which means aside from creating a enormous amount of dual diagnosis beds we are stuck dealing with an enormous increase in the complexity of the people we are caring for. This increase in complexity puts strain on every aspect of the health care system, but especially those on the front line (both the care providers and those they care for). I wonder if we should not take some of the advise we so often give our patients, and focus on our part of the problem and what we can change.
    Last edit by Tom RN, NRC on Dec 11, '14 : Reason: sp
  10. by   Isitpossible
    No, I think they should be grouped separately. I work in a acute psych facility and I work in another hospital on a detox unit. While working acute, there was a pt who was on the dual diagnosis unit. Unfortunately, he was actively detoxing from opiates and suffering the symptoms. However, I didn't believe he was being adequately managed, bc of his psych issues and their inability to provide MMT. I secretly wished he was on my detox unit at my other hospital, bc I'm sure he would have received better treatment and management. On my detox unit, pt often have psych issues as well, but the focus is the detox. Once they have passed through acute detox, they can move on to a psych unit for additional services needed.
  11. by   DharmaLynn
    There are not enough resources to create a unit for every single patient. That's why overlapping diagnoses are put in a unit. Individual care plans are established to cater to each client's needs.
  12. by   spongebob6286
    people with addiction are under psych prob...
  13. by   PeacockMaiden
    I a master's prepared RN who has worked in both an inpatient psychiatric facility and a crisis residential group home. I am in school for to get my psychiatric nurse practitioner certificate and a Doctor of Nursing Practice degree. The emphasis of my doctorate studies are patients who are dually diagnosed with a mental illness and substance use problem.

    The literature states that the prevalence of the dual diagnosis is about 60%. However, in my experience what I have seen is that the dual diagnosis is about 80-90% of patients.

    I do not think you can separate substance use with mental health. Metal illness establishes the propensity to abuse substances and substance abuse causes or exacerbates mental health challenges for the patient.

    So, to answer the question, I do think these problems can be grouped together.
  14. by   CASTLEGATES
    Post acute withdrawal syndrome can mimic schizophrenia, bipolar, PTSD, explosive d/o and others. This is why it's not recommended for addictionologists to stamp any new diagnoses on patients until they're finished wit PAWS. It can last anywhere from 2mos to 2yrs. Addiction is a disease, just like cancer. What do we do with a cancer patient who breaks his leg in an accident? We tend to place them in the unit where the most acute need determines where they go. This is the same with addictions at the psychiatric campus where I work. It's not fair to place addicts in a locked ward with people hallucinating, etc. Actually we had to learn this. A patient pursued this the legal route (when we did detox in a locked unit with psych) and the findings were--this was, in fact unreasonable and unjust to lock detox with acute psych (who can get violent), so no more detox patients into the locked units where I am (unless mental illness is the primary need). This is how triage, care, anything works (squeaky diagnosis gets oiled first) ha ha!

    Regarding the previous comments above: "The rest of them I couldn't care less what happens to them. They are generally, from my exp, ungrateful, needy, selfish, and just aholes?" Whoa Nelly! Did I just read an professional RN calling a diagnosis group aholes ???
    If you read no further; three letters E.A.P.!

    I don't feel it's remotely appropriate, or acceptable to name-call any diagnosis group. I had to do a double-take. If a patient is doing something where I feel I'm going to react emotionally, or negatively, I've completely lost my ability to help that person (and I need to move out of that area to a different specialty ASAP). My self actualization, nor does my career depend on patient gratitude (they're not on our units to please US)! My job is focused on saving lives from a continuous, progressive and fatal disease. It's not a moral character disorder where patients are (enter negative name here). Again, it's an AMA AANP ASAM diagnosed disease. Has anyone called diabetics idiots, or aholes because they did xyz to further their illness, became obese, cheated, etc. I take care of them, because they come to me asking (asking) for help. Withdrawals (acute and post-acute) make patients insane. Some are more difficult than others (psychiatry 101 for anger, manipulative redirection, anger management, safe handling, etc). It's my job to come to them armed with all this information, so they understand what's happening to them. I always tell them, "Although you feel like you're completely losing your mind, YOU"RE NOT." When they act manipulative, panic, angry, etc. I calmly let them know "It will get better, trust me, it will."

    In nearly all cases, once in recovery after PAWS, many can decrease or stop psych meds (obviously supervised, but these are the outcomes of recovery). It's nice to see the majority of professionals here taking it upon themselves to learn the most they can, ask legitimate questions and enjoy learning about a rapidly progressing specialty. Wouldn't it be great if we had staff who liked working with the most challenging patients, as well? I love my "druggies and drunks." The more manipulative, the better (because we have something to talk about, and I have an inroad to help them). I don't need any thank you's (my ego isn't fragile, and I already get paid as a thank you; never mind I'd do it for free).

    Last of my soap box chat...patients and other staff see, and react to body language, facial expressions and word choices that exude the feelings one harbors against addiction, races, religion, orientation, etc. People can see, feel and sense that, whereby the practitioner becomes therapeutically ineffective (and creates a toxic environment of the unit, as this behavior can be contagious).

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