Forcing patients to attend groups?

[femaleRN]

Does your inpatient psych unit force pt's to attend groups. My manager and some of my coworkers are talking about implementing this. Currently I highly encourage patients to attend, but don't force the issue. I feel like patients have a right to refuse, just as much as they can a medication. I'm scared of the extra busy work this will cause; patients falling, complaining of pain to get out of group and blow ups.

What does your unit do and how has it turned out, pro's and cons?

[femaleRN]

Totally agree with this.

[FolksBtrippin, BSN, RN]

Participants at our mental health day program got free transportation passes for the city. Some folks were just showing up for their trans passes and nothing else. Some people felt that this counted as malingering. So they changed the rules about when you could pick up your weekly trans pass and what the qualifications were. Some people discharged rather than meet the requirements. I am not sure that this was helpful to anyone. Those people may have been pretty stable, but they were definitely people with a strong history of mental illness. If the only reason they are stopping by is to get their trans passes, that means they are doing very well. But if they still stop by, they have a point of contact in case things go bad. Why is that a bad thing?

For a while, coming to program just for lunch was seen as malingering too, and they started giving out lunch tickets at the first group. If you weren't there, you didn't get a ticket and you didn't get lunch. This caused more problems than it solved, with people losing tickets and getting very upset.

My opinion is that this kind of thing isn't really malingering. It's just the participant making a decision about what kind of treatment is helpful. Taking away lunches and trans passes is not effective in supporting mental health, but does the opposite. Food insecurity and lack of transportation are risk factors for mental illness. We shouldn't try to punish people into receiving the kind of treatment we think they need.

I am wondering, how big of a problem is malingering in your facility? Do you think it is overestimated? What are the causes of the malingering? Is this fundamentally a housing problem?

[femaleRN]

Housing, substance abuse problem. Using the hospital as a flop house after they've blown through their disability checks. With that said I still believe these people are ill, many have the mentalities of teenagers, but I'm still going to treat them with respect. I feel like people I work with are trying to have a power struggle with these patients like they think they can really change these people. Majority of these patients aren't going to change even if u forced them to groups.

[Jules A, MSN]

I feel like people I work with are trying to have a power struggle with these patients like they think they can really change these people. Majority of these patients aren't going to change even if u forced them to groups.

Of course forcing groups in itself isn't going to result in major change but it might perhaps be a step toward maturing. For people with substance abuse issues it could possibly result in them realizing it isn't going to kill them to be a bit uncomfortable and they might in fact get something from the experience.

Some of "these people" actually can and do change but in my opinion it often requires others holding them accountable for the things that are expected of all adults. Minimizing their developmental status and allowing that to serve as a reason not to expect they are capable of growth is more disrespectful than encouraging and expecting them to follow the very basic rules of any given situation.

[FolksBtrippin, BSN, RN]

Housing, substance abuse problem. Using the hospital as a flop house after they've blown through their disability checks. With that said I still believe these people are ill, many have the mentalities of teenagers, but I'm still going to treat them with respect. I feel like people I work with are trying to have a power struggle with these patients like they think they can really change these people. Majority of these patients aren't going to change even if u forced them to groups.

What do you mean by using the hospital as a flophouse after they've blown through their disability checks?

Where were they staying before? Is it like, under a bridge, hotel, hospital, back to under the bridge, etc?

If they don't have a group home or other housing, that is the problem and forcing them to go to groups won't even touch it.

I agree that it is inviting a power struggle. A pointless one.

There might be reasons to force groups, but malingering is just not one of them.

[femaleRN]

I should of clarified substance abusers with antisocial personality disorder is what I meant.

[femaleRN]

They usually don't come out and say they've blown through their check, but we usually figure it out because it's a common story that they're all of a sudden not suicidal when there disability check is due. Usually couch surf "friends" or find hook up with other patients to stay with until they burn bridges with them. I do feel sorry for them, even though it's frustrating for the mental health system they're sick people.

[Jules A, MSN]

They usually don't come out and say they've blown through their check, but we usually figure it out because it's a common story that they're all of a sudden not suicidal when there disability check is due. Usually couch surf "friends" or find hook up with other patients to stay with until they burn bridges with them. I do feel sorry for them, even though it's frustrating for the mental health system they're sick people.

This is very common on inpatient units and I agree they are also sick. Imo a general acute inpatient psychiatric unit isn't the best place for them. Some of the larger hospitals have separate units specifically for dual diagnosis, psychosis, young adults, neuropsych, geripsych, detox etc and are a much better situation for all involved. Unfortunately with the sad state of affairs in mental health now the acute units are being squeezed beyond recognition.

[FolksBtrippin, BSN, RN]

They usually don't come out and say they've blown through their check, but we usually figure it out because it's a common story that they're all of a sudden not suicidal when there disability check is due. Usually couch surf "friends" or find hook up with other patients to stay with until they burn bridges with them. I do feel sorry for them, even though it's frustrating for the mental health system they're sick people.

Well that is the problem right there. The priority should be establishing stable housing for the people who will take it. Not all of them will.

Are there group homes for people on disability in your area? In NY, there is also mental health housing, for high functioning people who dont need/ want a group home environment. If you are not in a big city, you may have to go after more creative solutions.

As the nurse you could work this into your care plan, assessing readiness to explore housing alternatives to the hospital, and helping to set patients up with services that prevent readmission. For those that would work part time jobs, there are some programs that allow for this while still collecting disability. You could team up with the social worker.

If this is the way they've coped with low resources for a long time, its hard to change. You get comfortable.

But most people have aspirations.

The ACA is requiring hospitals to partner with community wellness and prevention in order to continue to receive federal funding. (And even if it gets repealed, it will take a long time to happen) So there should be some impetus already brewing for programs that prevent this.

You could be a pioneer.

[MiaLyse, APRN]

Where I work we do not lock rooms. I am glad we don't as I do not agree with the practice. We strongly encourage groups and we have times where some do not go for various reasons. I work on two different floors as well as the substance abuse floor. The intensive psychiatric unit has some very sick individuals who are not able to participate in group and most patients on the regular psychiatric unit do attend. On the substance abuse/detox unit, it is strongly encouraged and the patient agrees to attend groups prior to admission (our detox is voluntary)

[VivaLasViejas, ASN, RN]

From a patient's perspective: I'm so glad they didn't lock the rooms when I was IP. For one thing, that's where our bathrooms were, and for another it would have deprived us of what little privacy we were afforded. I was one who attended groups without prompting because I was motivated to get well, but being forced would have made me resentful and angry instead of willing. JMHO.