HE was sent back onto the streets??

Nurses General Nursing

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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 ER.

We had a similiar situation which I still don't get. Have thought about it a lot, and still don't understand what could have possibly happened to make anyone d/c this pt home.

Pt came in after seriously attempting suicide. You know the joke about if you're gonna try to kill yourself, make sure you get it right? He got it right and it was working the way he wanted it to...we just happened to get to him too quick. He was mad as Hell we kept him from dying. Kept telling us he was gonna finish the job as soon as he got out. The whole time he was in the hospital he was angry he wasn't dead. We all figured once he was medically stable he'd go to an inpatient psych unit for a long, long time. He was way too serious about ending things to be sent home.

Someway, somehow, he got discharged home. And straight to the pawn shop he went. Bought a gun. Drove cross country to shoot and kill a family member before turning the gun on himself. Sad, sad, sad situation...the only time since I've been a nurse I've kinda wished I had just let a patient die. If we had there would have been a different life saved...one that wanted to live.

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 . . .

Is it locking them down or is it getting them into treatment that could benefit them?

We had a similiar situation which I still don't get. Have thought about it a lot, and still don't understand what could have possibly happened to make anyone d/c this pt home.

Pt came in after seriously attempting suicide. You know the joke about if you're gonna try to kill yourself, make sure you get it right? He got it right and it was working the way he wanted it to...we just happened to get to him too quick. He was mad as Hell we kept him from dying. Kept telling us he was gonna finish the job as soon as he got out. The whole time he was in the hospital he was angry he wasn't dead. We all figured once he was medically stable he'd go to an inpatient psych unit for a long, long time. He was way too serious about ending things to be sent home.

Someway, somehow, he got discharged home. And straight to the pawn shop he went. Bought a gun. Drove cross country to shoot and kill a family member before turning the gun on himself. Sad, sad, sad situation...the only time since I've been a nurse I've kinda wished I had just let a patient die. If we had there would have been a different life saved...one that wanted to live.

Sounds like good material for a lawsuit.

neither is all schyzophrenia

Please clarify how schizophrenia is not mental illness. Thanks.:confused:

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....

Why did the doctor call his deputy friend? It seems to have worked out well but what was the doctor's original reason for calling the deputy?

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.

No money for this. Funny how there's money to pay Halliburton and other contractors $100 per load of soldier's laundry in Iraq, money to pay for their contracted trucks to run empty and the US taxpayer has to fork over big, big bucks to pay for them - and they charge for each base they pass in Iraq. Funny how some of the interrogators at Abu Ghraib were contractors and are not liable for maltreatment of the prisoners but our soldiers/Marines are being courtmartialed for same. There are about a billion dollars' worth of overcharging for supplying food, etc. to our soldiers in Iraq. Contractors in Iraq are leasing, for their top people over there, for about $250,000 per year, huge SUV's and luxury cars - for their secretaries, too, even though they don't have many places to go over there. And if the cars need work, there is no one to service them. The computers and some other gear that they supply is often intentionally ordered so that the wrong items arrive there. These are then burned and replacemet items are ordered, all at taxpayer expense. The contractors get paid for both the wrong items and the right ones. And all or most of the contracted workers are making 6 figures. Our soldiers are losing their health insurance, are put in harm's way, are missing seeing their families, and so on. The fighting men and women live in miserable tents. The contractors are in seaside resorts, complete with feasts, swimming pools, and every luxury one could possibly want. So how can we afford mental health care for our homeless veterans and other homeless people? Where are your priorities? BTW, Senator Leahy tried to get a bill passed that would have required punishment of these contractors and would have required that they make restitution but it failed, something like 44 - 52.

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:

it's not hard to commit people involuntarily where i am. all that is required is that a doctor fill out the right papers. i guess it's different in different states, locales.

google schyzophrenia+hoffer......generally speaking it is biochemical which makes it a physical disease, yes?

Specializes in Corrections, Cardiac, Hospice.

In our state there was a major lawsuit by an inmate in the 80's. He claimed mental illness that wasn't being treated by the state and it was a violation of his civil rights. He won. So what did the state do? The shut down all the state run mental hospitals and put all the money into the prison system to support the mentally ill. So, this is where our mentally ill end up - in prison.

Specializes in US Army.

I worked in the correctional setting for a few years, both county jail and state prison. If you want to experience psych conditions up close and personal, try working at your local jail.

Just like previous posters have stated, the correctional system has become an institution for mental illness. Yes, most states have a state hospital or two, but the bed space does not even come close to meeting the demand.

The limiting factor is simply that treating and managing severe mental illness is not very profitable...

Specializes in ICU, Telemetry.
Why did the doctor call his deputy friend? It seems to have worked out well but what was the doctor's original reason for calling the deputy?

Because our county has 1 15 bed psych facility, and they don't take violent pts., the doc knew the guy was going to be a clear and present danger to himself/others, but there was literally no where to put him. You can, however, get them into a state psych facility by getting them arrested when you can't get them into the facility any other way. All the deputy did (he had 3 witnesses so there couldn't be any problem - harrassment, provocation, etc.) was say, "good afternoon, sir" as he walked by -- and the guy swung at him, started screaming he was going to kill him, etc. If the guy had reacted with a "good afternoon" and walked on by, nothing would have been done. As it was, they guy went before the judge, judge remanded him to forensic treatment at a state facility, where he ended up getting treatment that we couldn't get him any other way.

Our state is not a good one to be in if you need help outside a metro area....

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