Psych patients and their reliability in taking meds

[ginger58, ASN, RN]

We've had several shootings of psych patients lately by the police, who were called by the family via 911 calls. The patients weren't taking their meds, and they became out of control. They didn't do what the police asked them to do and were shot.

In psych patients is this uncommon for patients to stop taking meds or is this part of the illness? I guess what I'm asking is, do they make an informed/educated decision to stop usually?

Do you know of any parts of the country that have successfully utilized a mental health team (non-police team) to de-escalate an out of control situation?

[MrChicagoRN, RN]

Mental Health patients stop taking their meds for lots of reasons.

Pretty much the same reasons the other folks do:

Side effects, not liking how they make them feel, "I'm better now, don't need them anymore (same thought process as with antibiotics), compliance apathy, forgetful, ran out of meds, can't afford them, etc

Non-adherence to medications is the biggest reason for rehospitalization.

If your local police are shooting decompensated patients, then that's really an issue the community needs to address with the police. And the police should already be looking at themselves.

[NurseCard, ADN]

This has happened in the area where I live also... people get out of control, don't do what the police tell them, and they are shot/tazed.

I'm honestly not sure that, out in the general public, police officers really have much choice but to at least taze someone who is completely out of control. They don't know if that person may have a weapon on them that they simply have not brandished yet. And if that person DOES have a weapon, and they brandish it... what can the officers do but taze, or shoot?

So, a de-escalation team, in theory, might be a good idea, but when you really think about it.. de-escalation works in a controlled setting like a hospital, where you are about 99.99 percent sure that the out of control person doesn't have a weapon. But out in public.. may not work quite so well.

And yes, it is far too common that psych patients get out of the hospital and almost immediately stop taking their meds. We have one "frequent flyer" who, on her meds can be the sweetest, funniest little thing, with her fixed but "pleasant" delusions. But then she gets released, gets placed somewhere, stops taking her meds, and comes back to us a few weeks later, ready to rip us all to shreds.

[NurseCard, ADN]

'Course then again... I guess you could have de-escalators who are specially and distinctly trained NOT to get shot. And if they do... they have on special armor or whatever.

Or you could have de-escalators who go out on calls right along with the armed officers.

Unfortunately, all too often, the police really have no way of knowing that they are just dealing with a mental patient who is decompensated.