Re: What would you do if you were making the decisions? 1) John, is participating in an outpatient substance abuse research program. As part of the program, she receives a voucher to be turned in to the business office for money as compensation for her participation in the study. One day, Mary decides to place an additional 0 at the end of the dollar amount. The business office notices this addition and calls the clinic to verify.
If Mary/John is participating in an outpatient research program it sounds like she is relatively stable and can be kicked out of the program as a consequence for her action (which is probably lawfully wrong - fraud/stealing.) However, that said, obviously Mary/John is psychiatrically unwell to some degree and removing her from the program with no follow up or care will be almost definitely detrimental to her health. Is it her first "offense"? Is a good talking to and a path of potential consequences all that is needed to send home the message that she has done the wrong thing and it will not be tolerated? Or is she a chronic offended who is non-compliant with treatment and doesn't want to be there?
2) Billy, Jeff, Carl, and Darryl are adolescent patients in a residential substance abuse treatment program. They decide to bring assorted products back from the cafeteria (e.g., fruit, sugar, bread) and make their own alcohol. Staff, during a search find the fermenting concoction.
These three probably don't want to be in treatment to start with. They probably need a lot of education (and experiences that hit home) before recovery becomes a real potential in their minds. As they are young, probably don't want to be there and will probably go straight back to their DOC as soon as they get out, I think they should be kept in the program with some serious consequences on how they are effecting their and others recovery. Separating the three and supervising their time in the cafeteria and otherwise seems appropriate also. A strike system may be in order, also, which increasing consequences for each new offense.
3) Jill, Mary, and Joe are patients in an inpatient psychiatric facility for depression. They decide to cheek their meds and at night crush them and snort them. Staff walk in on the trio while inhaling their crushed meds.
These three probably don't want to continue to suffer from depression but are to young and to sick to understand the important of compliance with the therapeutic regime. They're probably also bored and ****** off about being stuck in a crappy hospital. I think separating the three and increasing supervision in regard in meds (mouth checks at each dose) is a good place to start, as well as a hell of a lot of education.
5) Vince has been hospitalized in your inpatient psychiatric unit 3 times in the past 2 months. His story each time he presents to the ER is that he is depressed, suicidal with a plan to walk into traffic, and hearing voices that tell him to harm himself. He also reports using crack cocaine on a regular basis. At each discharge there is a plan established, but he does not follow through on his end, only saying that he can't. When he gets onto the unit, he becomes demanding for food and medications (pain meds and psychotropics that will knock him out), refuses to take a majority of his non-sleep inducing psychiatric medications, and is disruptive to the millieu.
5) Vince sounds like he needs a good talking to and to be made aware that he actions are starting to become fairly transparent. I would suggest that Vince was encouraged or forced to attend appropriate substance abuse treatment, educated appropriately about the drugs, his illness and their effect (which I expect has been done) and arrange for a community treatment order following discharge so that he DOES follow up with his discharge planning in order to prevent a future admission for the same reason. It sounds like Vince needs steel consequences for his actions in order to reinforce their negative and unhelpful nature and encourage compliance with the therapeutic regime. Perhaps explaining to Vince that the physician prescribes drugs, not the patient, wouldn't go astray, either.
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