Update: About a month ago I was doing an intake interview with a patient for a chemical dependency unit. I kept it light and easy, and used the Suicide/Safety Plan paperwork to establish that I don't think he's suicidal, this is just some paperwork the hospital requires because of past incidents. Just play along, pretend this is worthwhile, we'll get through it and go on to the next piece of paperwork we have to do.
I hate paperwork. Let's just bomb through this and get to something worthwhile.
I repeated that line of thought later in the intake interview. I'm still not sure why I started engaging with patients this way but it's had an interesting effect on the intake interview process. I pretend I don't really care about the answers, and the patients tell me things they wouldn't say if it was serious.
This one particular patient wound up confiding to me that he robbed people for drug money. Robbery, I said, what's that? Is that different from burglary? He explained that it's a more 1 on 1 thing, where you take stuff from people and not from places. "Give me your **** or I'm going to pound on you." Well. That was an entirely different thing from what he told the intake staff. "I won't write any of this down. What do you mean, you robbed people?"
He broke it down for me in an interesting way. Afterwards I took him to the courtyard for a smoke and then off to dinner. About an hour later he went to another staff and said he wanted to leave AMA. Internally I was very relieved. This guy wasn't here for treatment, he was here to get the heat off so he could go back to doing what he did. Hey, who am I to judge, but there are fragile patients on the ward who wouldn't appreciate a criminal predator who uses direct threats of violence to intimidate people into coughing up drugs.
We pass out a lot of drugs on the chemical dependency ward.
Not a good mix.
Anything that helps you sniff out a patient like that is worthwhile. The TV show Lie To Me is pretty good. There are tons of good movies and books that will help you out. Find a way to learn about it and go from there.