Is a level of behavioral health nursing missing?

Nurses General Nursing

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  1. Do you think that a "scared straight" type psych unit or facility has potential?

    • 0
      No. We are too worried about lawsuits from patients and/or families.
    • 0
      No. Let the jails and prisons deal with it.
    • 0
      No. We don't want to hurt our patient satisfaction scores.
    • 12
      No. Other.
    • 0
      Yes. I think it would put some relief on the overcrowded corrections system.
    • 1
      Yes. Sometimes punishment or restraint for aggression/violence is needed.
    • 1
      Yes. We are tired of getting physically assaulted by aggressive patients.
    • 1
      Yes. Other.

15 members have participated

I've only been in behavioral-health nursing/tech'ing for a couple of years now. I've noticed that many nurses are excellent at comforting and caring for psychiatric patients with suicidal or depression diagnoses, but notice that a majority of nurses do very little with patients with borderline and aggressive diagnoses. I've seen nurses, techs and some social workers do all in their power to avoid contact with borderline and aggressive patients. Certainly there is a sense of fear with particular patients under these diagnoses, but are we doing them or society any justice? Are we providing behavioral health that will allow them to become more social and even-tempered in society by simply avoiding them and strictly giving them ordered meds?

I've read a recent article that mentioned a particular (general) hospital organization that sold it's behavioral health operation to a focused, behavioral health hospital organization. The municipality where the facility is, was ecstatic about the new owner organization's potential to serve their community. The mentioned that there are psychiatric patients in their community that are under-served. They mentioned how patients either can get the psychiatric care they need or likely end up in the prison system.

It appears to me that there is a missing piece in behavioral healthcare today. While we are great at managing suicidal ideation, some bipolar, depression, some mania, some schizophrenia, we are not great at preventing violence and crime in society which certainly must include some mental-health component . Traditional healthcare won't allow the tools necessary to provide behavioral health for aggressive patients, sociopathic, or psychiatric patients with criminal tendencies. A full hospital organization that does not have distinct separation of patient satisfaction scores (ie. does not exclude customer satisfaction scores from a mental health unit) will always, in my opinion, will never be able to provide proper mental health care to those patients with aggressive or violent components of their mental illness.

Many of us have seen shows like "scared straight". Those types of behavioral programs have apparently been successful at curbing attitudes and keeping kids out of the prison system. I would like your feedback on whether or not you think there is some merit in having a "scared-straight" type mental health unit or separate psychiatric facility that is monitored and co-sponsored by municipalities (health and corrections divisions) to attempt to truly provide care to aggressive or violent mental health patients to keep them out of the prison system and perhaps prevent further school shootings, hate crimes, and the like.

Depending on the age of the patient and the severity of the problem. If the person is already well established in conduct disorder, with a home environment to match, outpatient therapy is unlikely to be effective.

More research is needed. We can't currently identify who will become a hard-core and dangerous antisocial.

I am probably jaded from years of work in corrections. All that razor wire went to my head.

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Absolutely. This is an inquiry to professionals to solve a problem. Thanks for your input.

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Specializes in Case Manager/Administrator.

As a healthcare professional who has worked in the prison system I can tell you this is why I do not think a "Scared Straight" will work with mental health patients:

Most mental health patients I have ever come across have serious MH complex needs and I would say 99% of them have axsis II diagnosis meaning personality disorders. I see men and women solidify their actions/reactions and refine them by at least age 22-right or wrong. This means they keep going back to what they know. When you think of Ericksons staging they are usually stuck between age 6 to 18 years of age in the prison system and when dealing with patients they act between the ages of 6 to 18. For what ever reason they cannot get past those stages when stressed, mad, frustrated, angry or are just going to manipulate whom ever they are talking with. Personality disorders are some of the most difficult to deal with when working with MH patients. Its kind of like geriatrics you know what it is on the surface but you do not want to learn any more than you have to about it. Since they have refined their actions/reactions and what life experiences they do have being scared straight only allows them to develop their present "at stages" even more.

For organic mental health diagnosis i.e. Schizophrenia or say dementia of some kind I fear scared straight may make their illness into an acute exacerbation and have no desire to participate in this sort of MH treatment plan.

I have had some pretty intensive talks with patients over the years with mental health patients and staff members and to me the only thing will change is on an individual basis, new environment for at least 2 years and ongoing counseling to which they can arrive safely at imparting some wisdom nugget to others who are in a stage where that patient use to be.

Remember some people will not change and only learn how to manipulate better and better....these people belong in a prison when they break the law.

I agree we need to do more for mental health and have no ideal why we separate mental health from medical to me this is where we should start by bringing our medical presentations under one umbrella.

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I'm not entirely certain that any treatment works well for borderline or whatever psychopathy is currently called. They are personality disorders and while I'm not a psych nurse, the main issue with personality disorders is that they are a basic portion of that patients personality. Most people can't really control that or even want to control it (psychopathy) and it is a spectrum.

With some other mental illnesses I would think that the scared straight method would make things worse. If the person was capable of considering consequences of actions prior to making those actions they probably would already do so. I think that's why it's considered an illness.

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We are discussing multiple and divergent clinical scenarios here.

Scenarios that are frequently co-mingled and very difficult to diagnose, especially in an outpatient setting.

The outpatient clinician usually only has the word, and perspective of the patient. It is usually wrong. Sometimes it is a lie, more often it is just inaccurate.

The clinician's biases also matter.

Many years ago, a psychiatrist I saw diagnosed me with "oppositional/defiant disorder" when I saw him, at the age of 37. This was after I sought help for intense anxiety and depression, after a couple of different RN jobs didn't work out, one of which I had for almost 5 years.

In his mind and experience, nurses were only ever fired for coming to work late, poor attendance , or drug diversion. He was well into his 50's at the time.

As a physician, he was completely unaware of the political nonsense that goes on in nursing.

I found that physicians tend to feel they "know" what goes on with nurses in a facility, just because they are physically in the building and have superficial interactions with them.

I got out of that toxic environment, and eventually earned NP credentials.

All of a sudden, I am allowed to express my opinions, without being considered oppositional or defiant.

IT WAS WORTH IT.

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