HE was sent back onto the streets??

[DebRN06]

had a homeless schitzophrenic pt on our unit and after a few days off found out he was d/c'd to a homeless shelter. i cannot understand how this man was d/c'd back on to the streets. he was flat-out scary. completely delusional and aggressive. he was in 4-point restaints the whole time he was there, up until they gave him some disposable scrubs and sent him on his way. there were even four code strongs called on this guy that day and he was swingin at staff!! there was another called in the lobby when he was being brought to his cab.

now, i was not there when he was d/c'd or for a few days prior. but, i cannot wrap my head around how/why he was not transfered to a mental health facility. there is no way i could have allowed that had i been there that day. this man is an absolute danger to society. he had threatened to kill me and other co-workers (documented) and poor marykate and ashley have no idea the grave danger they are in when this man (along with tom cruise) find them. (sry...not funny...kinda). he stated he had done some horrible things to his parents and was "not done with them" (also documented).

the only answer i got from the nurse that d/c'd him was that psych ok'd him for d/c. scary.

anyone ever experience something like this? i am just shocked.

[CoffeeRTC, BSN, RN]

wow, wow, wow.

I know in our area, there is a shortage on beds in community settings for those with mental health issues and they are closing the state centers that have been doing a decent job. WTH? I don't get it.

A few pts were sent out of these places and yes.....they ended up killing themselves and hurting others....go figure!

[MadisonsMomRN, BSN, RN]

I do not agree with this either. If he's a danger to himself and others I don't see how he was even discharged. He will probably end up in jail when he needs to be helped mentally! Sadly enough, this is where a lot of our mentally disturbed people end up! Instead of building more jails they need to increase the mental hospitals to get these people help. (even though half of them stop their meds when they get on street after receiving help)

That is scary!

[Vito Andolini]

It sounds like he should have been sent to a mental hospital. What about duty to warn Mary Kate and Ashley? Parents?

Although I must add that I see where patients are discharged all the time to homeless shelters. Or, if they won't do the work of trying to find a place to go, they are even discharged to the street. Not sure of the legalities involved but it sounds totally messed up. He needs care, society needs protection.

[hellerd2003, RN]

Depends on the issues at time of discharge. The OP states that she was off duty for a few days prior to the patient's discharge.

So, the patient could have been lucid and medicated properly, and passed a psych eval. What happens during a psych flare-up has nothing to do with a properly medicated patient.

One would question the discharge if there were not social services applied to the patient, and following him up in the shelter. Some shelters offer psych assistance. Some states/ communities have intensive rehab teams that will follow up with a person even if they're on the streets. If the patient was discharged while satisfactorily medicated, and follow up services were in place, this would not be an unsafe discharge.

To play devil's advocate . . . As a comparison, think of the drunk, belligerent, aggressive, withdrawing EtOH'er. After detox and withdrawals, many are very pleasant. We D/C them home with an admonishment to not drink. We don't discharge them to rehab. We KNOW the condition will, in all likelihood, recur-- and they will be as aggressive. But we D/C them if stable regardless. Which, to play devil's advocate further, makes me question why we target the mentally ill so much and try to lock them down, when research shows more crimes against persons are created by EtOH abuse than mental illnesses . . .

[MadisonsMomRN, BSN, RN]

Depends on the issues at time of discharge. The OP states that she was off duty for a few days prior to the patient's discharge.

So, the patient could have been lucid and medicated properly, and passed a psych eval. What happens during a psych flare-up has nothing to do with a properly medicated patient.

One would question the discharge if there were not social services applied to the patient, and following him up in the shelter. Some shelters offer psych assistance. Some states/ communities have intensive rehab teams that will follow up with a person even if they're on the streets. If the patient was discharged while satisfactorily medicated, and follow up services were in place, this would not be an unsafe discharge.

To play devil's advocate . . . As a comparison, think of the drunk, belligerent, aggressive, withdrawing EtOH'er. After detox and withdrawals, many are very pleasant. We D/C them home with an admonishment to not drink. We don't discharge them to rehab. We KNOW the condition will, in all likelihood, recur-- and they will be as aggressive. But we D/C them if stable regardless. Which, to play devil's advocate further, makes me question why we target the mentally ill so much and try to lock them down, when research shows more crimes against persons are created by EtOH abuse than mental illnesses . . .

You are absolutely right. Especially this statement " Which, to play devil's advocate further, makes me question why we target the mentally ill so much and try to lock them down, when research shows more crimes against persons are created by EtOH abuse than mental illnesses . . "

[BlueRidgeHomeRN]

had a homeless schitzophrenic pt .... i cannot wrap my head around how/why he was not transfered to a mental health facility. there is no way i could have allowed that .[/quote]

how would you have stopped it?? kidnapping and false imprisonment are felonies...

thank the aclu and "deinstitutionalization" that occured in the 1960's as part of "the great society" for this problem. it was decided that the mentally ill did not need to be locked up (true) but needed community services (which were never funded or built). americans have the right to be crazy and homeless....

[DebRN06]

Depends on the issues at time of discharge. The OP states that she was off duty for a few days prior to the patient's discharge.

So, the patient could have been lucid and medicated properly, and passed a psych eval. What happens during a psych flare-up has nothing to do with a properly medicated patient.

I was off duty. But, was given the low-down on what happened... 4 code strongs called on unit, pt swingin at staff, code strong called in lobby. That all happened the day he was d/c'd. He was obviously not properly medicated or lucid.

He needed to be transfered to a mental health facility to get the help he needs, get him medicated and to protect himself (and others) from his aggression and delusions.

I am sorry, I would not want to run into this man on the streets. I would not want him wandering the streets in my neighborhood (or anyone else's for that matter) in the state he was d/c'd in.

As far as the etoh comparison, I get it, but what happened with this particular man is the same as d/c'ing an etoh pt in the midst of detox & withdrawal.

[jadu1106]

ummmm. wow. scary. so scary.

[jadu1106]

had a homeless schitzophrenic pt .... i cannot wrap my head around how/why he was not transfered to a mental health facility. there is no way i could have allowed that .[/quote]

how would you have stopped it?? kidnapping and false imprisonment are felonies...

thank the aclu and "deinstitutionalization" that occured in the 1960's as part of "the great society" for this problem. it was decided that the mentally ill did not need to be locked up (true) but needed community services (which were never funded or built). americans have the right to be crazy and homeless....

i think she is just trying to say she would have checked to see if anything else could have been done for his d/c instead of sending him right back into the street as dangerous as he was.....i seriously don't think she meant anything in regards to kidnapping and false imprisonment.....

[DebRN06]

how would you have stopped it?? kidnapping and false imprisonment are felonies...

thank the aclu and "deinstitutionalization" that occured in the 1960's as part of "the great society" for this problem. it was decided that the mentally ill did not need to be locked up (true) but needed community services (which were never funded or built). americans have the right to be crazy and homeless....

don't think i would have had to kidnap or false-imprison...i guess i would have questioned the md... maybe detail the need for the following to be filled out:

petition for involuntary/judicial admission

**a person with mental illness and who because of his or her illness is reasonably expected to engage in dangerous conduct which may include threatening behavior or conduct that places that person or another individual in reasonable expectation of being harmed;

**a person with mental illness and who because of his or her illness is unable to provide for his or her basic physical needs so as to guard a person with mental illness who, because of the nature of his or her illness, is unable to understand his or her need for treatment and who, if not treated, is reasonably expected to suffer or continue to suffer mental deterioration or emotional deterioration, or both, to the point that the person is reasonably expected to engage in dangerous conduct;

**in need of immediate hospitalization for the prevention of such harm.

i base the foregoing assertion on the following (provide a detailed statement including a description of the signs and symptoms of a mental illness and of any, acts, threats, or other behavior or pattern of behavior supporting the assertionand the time and place of their occurrence. additional page(s) may be attached as necessary)

i do not believe every "crazy" person needs to be locked up. not what i am saying. but this guy is a danger to himself and others.... is this not why the involuntary petition exists? to protect people (whether from themselves or to others) and to (hopefully) help the person? i agree, more community resources need to be available.

[BlueRidgeHomeRN]

this guy is a danger to himself and others.... is this not why the involuntary petition exists? to protect people (whether from themselves or to others) and to (hopefully) help the person? i agree, more community resources need to be available.

obviously the md thought otherwise, and/or there were no beds available. i do not disagree with your assessment, i was pointing out that it is very difficult to involuntarily admit someone (at least in the states i have practiced in) and that civil rights trump all in most cases.

there are no beds, there is no money, and even if these were not a problem, mentally ill patients become "sane" when medicated, are released by the judicial system, go off their meds, and repeat, ad nauseum.