Depressed self-referral to ED

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Just curious how other hospitals might have handled the situation. Early 40's female pt self-referred to ED complaining of feeling depressed and suicidal ideation - no plan, however. It was a little surreal because pt appeared well-put-together - very calm and composed. However, pt admitted to drinking earlier. Pt attempted to leave before her psych eval could be conducted, saying she felt better and had changed her mind. At that point, pt was re-directed to a locked room, her clothing, underwear were taken, ankle to ankle restraints applied. She ended up being discharged after her eval. Didn't know what other hospital policies might be in similar situation.

Specializes in Psychiatry, Community, Nurse Manager, hospice.

"You really need to avoid relying on your own subjective discretion here, but rather, be familiar with the laws and policies that guide practice in your particular facility."

I very strongly disagree. OP, you need to ask yourself in this situation, "Was this right? Did this harm my patient?"

Then take action, whether it's a policy issue or a provider issue.

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Specializes in ICU.

This reminds me of how ALL psych pts in my state are handcuffed when being transported to an outside facility.

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Specializes in Cardiac, ER.

While this may have been a bit overkill for this specific patient,..this is exactly what would happen in my ED. If you tell me that you are depressed, having thoughts of suicide (enough thought that you sought help in the ED) and you had been drinking, you aren't leaving until psych clears you. I don't want to have to explain to a judge and your family why, after you told me you were depressed, told me you were having thoughts of suicide, told me you were drinking, I wrote it all down,...and then I let you leave to walk into traffic and die.

Your thoughts of a 'well put together" person who was dressed nicely are just invalid. I've coded many a patients wearing $3000 suits and Italian leather shoes after they OD'd, shot themselves etc. If you tell me that your are depressed and thinking of killing yourself you aren't leaving.

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I also cannot tell you how many patients I saw in my short 7 weeks of working in a psych ER where we've had VERY drunk people (like BAL over 300) saying they wanted to kill themselves then once they sobered up, they don't even remember making those statements. They're still taken just as seriously and you still have to be evaluated

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I am only a student but this goes against anything I have learned or participated in on the wards. The restraint sounds extremely unethical and unecessary. I could never see this being done in any of the wards I have worked on simply because she was merely asking for help/support and was not threatening by any means. I would assume the locked door is enough (maybe even too much) of a restraint. I do understand that she needs to be assessed after confessing her suicidal thoughts before leaving, but is there a more practical way it could have been done?

May I ask why all of her clothes were removed?

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Im not advocating her treatment one way or the other. I did think/have stated that I thought it may have been a bit overboard but that's a all. I agree the restraints didn't seem necessary, but they didn't stay on that long either, and I think it was partly due to lack of understanding if she was going to stay in that room or if it would be locked.

She was considered higher risk at the point we took her clothes. That is what I actually found most unsettling/not necessarily necessary...Again there was some confusion on her underwear, she should have been able to keep that I think. But she had to stay that way for quite a while - up until she was allowed to leave. I felt bad for that.

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Specializes in Critical Care.
She didn't have a plan, though.

Didn't verbalize a plan. The plan could be in motion though.

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I am only a student but this goes against anything I have learned or participated in on the wards. The restraint sounds extremely unethical and unecessary. I could never see this being done in any of the wards I have worked on simply because she was merely asking for help/support and was not threatening by any means. I would assume the locked door is enough (maybe even too much) of a restraint. I do understand that she needs to be assessed after confessing her suicidal thoughts before leaving, but is there a more practical way it could have been done?

May I ask why all of her clothes were removed?

I know, this is ridiculous. The person is already feeling crappy enough to want to kill themselves and they are subjected to very degrading treatment IMO. Oh, but they might harm themselves is the logic used. No, it's just another way to degrade someone who is already feeling like crap because they might have the notion to kill themselves. I fail to see the reason why this is a crime in the first place. The lawmakers ought to spend more time worrying about THEIR conduct instead of passing asinine laws regarding the topic.

Also, if a person wants to kill themselves they're going to do it regardless of any inpatient treatment. People like this are put on pills that are supposed to make you happy because you're so stoned from them. Psychiatric medication is powerful stuff. And it's even more interesting that these types of drugs are what people usually do wind up ODing on and actually catching the bus.

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Im not advocating her treatment one way or the other. I did think/have stated that I thought it may have been a bit overboard but that's a all. I agree the restraints didn't seem necessary, but they didn't stay on that long either, and I think it was partly due to lack of understanding if she was going to stay in that room or if it would be locked.

She was considered higher risk at the point we took her clothes. That is what I actually found most unsettling/not necessarily necessary...Again there was some confusion on her underwear, she should have been able to keep that I think. But she had to stay that way for quite a while - up until she was allowed to leave. I felt bad for that.

Like someone said, the next time she is feeling that way she is going to remember how she was treated and not go to the ER for help. smh

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Specializes in Critical Care.

It's not a crime. And the reaction(s) of healthcare professionals are not meant to be degrading (although hey certainly can be felt so). If someone threatens self-harm, we pull out all the stops. Underwear taken seems way overboard to me, but I guess they could be like shoelaces or socks....wrap them around your neck and find something to hook them on...BAM...homemade noose. It sucks, but it is practical for one in need.

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It's not a crime. And the reaction(s) of healthcare professionals are not meant to be degrading (although hey certainly can be felt so). If someone threatens self-harm, we pull out all the stops. Underwear taken seems way overboard to me, but I guess they could be like shoelaces or socks....wrap them around your neck and find something to hook them on...BAM...homemade noose. It sucks, but it is practical for one in need.

You never know what a mentally ill person could do with their underwear. Solid precaution taken in this case.

Has no one read "99 ways to kill someone with your underwear?"

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Specializes in Critical Care.
You never know what a mentally ill person could do with their underwear. Solid precaution taken in this case.

Has no one read "99 ways to kill someone with your underwear?"

You know, in a pinch, one could make it work...

Probably a YouTube instructional video out there.

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