HE was sent back onto the streets??

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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!!:eek: there was another called in the lobby when he was being brought to his cab.:banghead:

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.

Specializes in Advanced Practice, surgery.

As a qualified nurse we can overide a medical decision to discharge if we feel it is unsafe.

Specializes in Home Care, Hospice, OB.
as a qualified nurse we can overide a medical decision to discharge if we feel it is unsafe.

not over here, sharrie---only physicians and clinical social workers can involuntarily commit. nurses can intervene, but can't override a md decision except if another md (ie, medical director) is involved. [again..i have not worked in every us state, so this may vary..]

Specializes in Advanced Practice, surgery.
not over here, sharrie---only physicians and clinical social workers can involuntarily commit. nurses can intervene, but can't override a md decision except if another md (ie, medical director) is involved. [again..i have not worked in every us state, so this may vary..]

would that come down to money as we don't charge for our beds, (not wanting to take this off topic) but sometimes a patient can be medically fit but have nursing needs that make them unfit for a safe discharge, obviously we would try to make sure the medics are on board with the decision to delay discharge but it is the nurse who actions the discharge orders and if we feel it's not safe we don't action it. i have often over-ridden a discharge decision because i felt it unsafe

Specializes in Home Care, Hospice, OB.
would that come down to money ?

beyond a $hadow of a doubt!!!!

Specializes in Cardiac Telemetry, ED.

There were probably no beds available in any psych facilities. Maybe he'll do something where the police will have to intervene, and he'll be put in jail (but then released due to overcrowding there).

blueridgehomern;3121842 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.:banghead:

i did not take offense to your post (in case you thought i did). it just frustrates/confuses me that i have seen others petitioned with far less mental health issues than this man and they have stayed on our unit for days until a bed opened. again, i wasn't there, but 5 total code strongs and documented threats to numerous people?? if something were to happen (to pt or another) would not the hospital and md be liable?

i have very limited experience with psych... only which i see on a tele unit. i actually hope to never have that much experience with psych as it is not my forte. so, i am not used to this kind of thing. i was curious if this is the norm so to speak. regardless, it is sad... for many. i cant tell you how bad i felt for this man, living in the hell of his mind, and for the parents/family that "lost" him to his illness.

Specializes in ER,ICU,L+D,OR.

Very unfortunately with psych beds at a premium because they are so short of beds, and funds. Sending him out to a homeless shelter is probably the best they can manage. This nothing new by any stretch of thought. I disagree with it, but under the current system. Where there are so many mentally disabled people out there without insurance or any means of making a living. There just isnt anything to do under the current socio-political situation. Maybe it is time for things to "Change" Rather than bailing out big insurance and investment companies, maybe we can take care of some of the Americans in this country who need our help.

Specializes in ER,ICU,L+D,OR.

What are they going to do in the what is it, the next 10 years when the Alzheimers population is supposed to hit 20 million.

Specializes in Home Care, Hospice, OB.
what are they going to do in the what is it, the next 10 years when the alzheimers population is supposed to hit 20 million.

dementia is not mental illness.:no:

Specializes in ICU, Telemetry.

I've had a pt that sounds very similar to the OP's pt -- and we tried to get him placement. However, because he was homeless, had no income, had no proof of residency, had no long standing H/P that could point out this was a chronic vs. acute incident (a spontaneous burst of schizophrenia in your 50's with no prior incidents, yeah, right), we couldn't get the state facilities to take him, and no private pay was going to eat the bill. We even had his fiingerprints taken and ran to see if he was a vet and maybe the VA could help (and didn't that take about a gallon of thorazine...)

He was too freakin' dangerous for the local nursing homes to take him while trying to get medicaid set up (he tried to bite the intake coordiinator, not a way to get a bed...). Literally, nobody would take him.

So what happened was the doc called a friend of his with the sheriff's dept -- the pt reacted very, very badly to uniforms -- discharged the pt, deputy came up to him at the curb, pt swung at him, and off to jail he went. At least there, he's inside, clothed, getting food and meds, which he wouldn't have on the streets. Not a good solution, but better than him killing someone at the Walmart because his voices told him to....

dementia is not mental illness.:no:

neither is all schyzophrenia

Specializes in Critical Care.
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.

If he were that violent at time of discharge, either he was very, VERY convincing to the psych evaluator, or he is manipulative, or his codes were due to a short fuse, or you live in a state with terrible mental health supportive services (i.e., system overwhelmed/ nonexistent) or a combination of the four. If all that happened on day of discharge, then he shouldn't have been let go.

Another question: was proper legal paperwork in place? If not, then if he was medically stable, it doesn't matter if he's crazy as heck. You can't hold a person against their will if no legal paperwork (called a 72 hour hold or Legal 2000) is signed by an MD. Sometimes docs forget to sign the paperwork, and if it wasn't signed, then the pt walks.

If that wasn't the case, then I don't know what to say (and I worked in psych settings for years, so I "get" the psych hospital/ inpatient vs. psych community stuff).

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