Due to the Coronavirus, are freed prison inmates going to malinger their way into psychiatric hospitals?

[A Hit With The Ladies, BSN, RN]

I work inpatient psych and I noticed over the past two weeks the acuity level of the patients on my unit has dramatically increased. So many are incredibly violent, combative, mean, demanding - far more so than what is normal on my unit. I genuinely felt overwhelmed and largely defenseless, despite having techs on my unit.

The nurse I got report from says it's because a lot of these freed inmates will simply say "Oh I'm suicidal" and get transferred from a county hospital to the psych hospital. I find it quite plausible really.

[toomuchbaloney]

Sounds like you are describing behavioral or mental health issues though, right?

[moriahcat]

Without violating HIPAA, can you confirm if the combative pts you're dealing with actually *were* released from prison?

I would imagine that, just like most non-COVID areas of care, psychiatrists aren't wanting to admit their pts unless they desperately need it. So lower acuity pts who would benefit from inpatient but can be managed with close psych guidance are probably not being admitted.

Then add in being in a hospital (the place most people think they are going to catch COVID) to already existing mental health issues. Fear/anxiety about something they cannot control would exacerbate issues.

[A Hit With The Ladies, BSN, RN]

It would say so on their initial psych evaluation documents

[moriahcat]

3 minutes ago, A Hit With The Ladies said:

It would say so on their initial psych evaluation documents

Thanks, reason I asked was that you weren't clear (perhaps purposefully to protect their privacy) if these combative pts were actually released inmates or not.

If not released inmates, then I'd attribute the high acuity/high level of combativeness to already being in an extremely poor condition to get admitted in the first place, and then having no choice but to be in a hospital during a pandemic (where nurses/techs are trying their best to stay healthy but the individual themselves can't know that for sure).

Anything that creates a sense of helplessness/hopelessness will exacerbate mental instability -- and you're used to the normal level of that which comes from admission itself (as a hospital is a place where the pt does not have control over their environment). Pdocs not admitting until pts are clearly off the rails combined with worry over a pandemic could potentially cause what you're seeing, regardless of past incarceration status.

[A Hit With The Ladies, BSN, RN]

That's not the case at all. Medical hospitals often have beds contracted out with psych facilities to funnel patients there. The problem is that when you have legions of released inmates that are too dangerous to house in a shelter (that won't accept them) and with zero income or family willing to take them in, they are going to exploit the mental health system for their 3 hots and a cot. And psych staff are not corrections officers. We don't have weapons, we don't have tasers, heck, we don't even have holding areas (it's already difficult enough to get someone secluded) for such a dangerous population. There is no psych diagnosis in place when they take their gang-related battles out on the unit and make the other patients uncomfortable.

[toomuchbaloney]

That's how we do mental health care in the USA now. There's not much investment there because it isn't a large profit center.

[moriahcat]

3 minutes ago, A Hit With The Ladies said:

The problem is that when you have legions of released inmates that are too dangerous to house in a shelter (that won't accept them) and with zero income or family willing to take them in, they are going to exploit the mental health system for their 3 hots and a cot. And psych staff are not corrections officers.

I was more trying to help you deal with your current pts, and you still haven't answered whether you know for certain the ones that are being so combative are indeed "exploit(ing) the mental health system" after early release.

But since you haven't answered it, you may not feel you are able to without violating their privacy, so I'm going to assume and give you the benefit of the doubt that yes, the combative pts you are dealing with are part of the "legions of released inmates".

If there is no psychiatric diagnosis that can be treated in an acute inpatient setting, then perhaps you and the other nurses can explain that to the doctors and see if discharge (because if there is nothing psychiatric to treat, acute inpatient psych is not where they belong) just means they will come back in a day (with street drugs in them to boot) or might actually help.

Or if discharge is not possible, heavy third-generation antipsychotics to treat the combativeness -- as in, enough to qualify as "chemical restraint"? I mean, it might make dealing with them easier. And surely you and your colleagues have seen NMS enough to know if it's happening (despite third-generation antipsychotics having far less likelihood of causing it than good old fashioned Haldol), so it would be a safer alternative for all involved.

[A Hit With The Ladies, BSN, RN]

The appropriate setting is a psych unit or psych care within the prisons themselves. The prisons have adequate armed, trained staff to manage their combative behaviors. Psych hospitals do not. Plus, given the insane logic of releasing prison inmates due to Coronavirus, what incentive do they have to behave? Are the courts going to send them back to prison at this time when they can play the "But I'm mentally ill" card? If the unit cannot be kept at a reasonable level of safety what exactly are staff supposed to do? We don't have endless supplies of seclusion rooms to use as de facto jail cells.

[toomuchbaloney]

Incarceration of the mentally ill is not a new phenomenon in this country.

[Emergent, RN]

There are a large amount of people who know how to play the system. These are people with nothing to lose. Because we are always bending over backwards to help people, they figure it out pretty quickly. Our Healthcare System is big on rights and doesn't really demand too much in the way of responsibilities.

[toomuchbaloney]

1 hour ago, Emergent said:

There are a large amount of people who know how to play the system. These are people with nothing to lose. Because we are always bending over backwards to help people, they figure it out pretty quickly. Our Healthcare System is big on rights and doesn't really demand too much in the way of responsibilities.

Lots of our society is not big on accountability. Accountability often is very much related to wealth, celebrity, or influence in this country