HELP!

The person has shown the symptoms of Schizophrenia( hallucination, delusions). She is brought to the emergency department and going to be admitted to Psychiatric Unit. She wants to leave and what should a nurse says to her?

Having schizophrenia in itself is not justification to automatically admit the patient against their will.

To hold a patient in a psychiatric hospital against their will, one of three criteria needs to be met:

1. They are a danger to themselves

2. They are a danger to others

3. They are gravely disabled, meaning that they unable to provide for their basic need such as food, clothing, shelter, hygiene. This doesn't mean they have to have these resources handy--they just have to know how to access and use them. Or they have someone--family, friend, caretaker--who can help them meet these needs. For example, if someone opts not to go to a shelter but to be homeless, and is otherwise taking care of their other needs, that doesn't necessarily mean they're gravely disabled.

The call as to whether they should be admitted would be made by a psychiatrist. If she has hallucinations and delusions but is otherwise not a danger to herself/others and can meet her basic needs, they really can't force her to stay against her will. They can strongly encourage her to stay, but if she doesn't meet criteria for a hold, she can't stay.

Again, having symptoms of schizophrenia in itself does not mean they're gravely disabled. A lot of people with chronic psychiatric illnesses will still experience symptoms such as hallucinations and delusions, but they are able to manage them and can continue functioning safely.

If they do put her on a psychiatric hold, or if she came in to the ED on a psychiatric hold, that doesn't mean an automatic bed at Casa Psych. The hold means that she can be detained for psychiatric evaluation and treatment IF it is determined to be necessary. A psychiatrist may assess her in the ED and determine that she's not holdable, in which case she would be free to leave if she chooses.

Let's say that she came in on a psych hold. Upon assessment, it's determined that she is in fact gravely disabled. So she's getting admitted like it or not.

Exactly what you would say to her would be tweaked based on how she is currently presenting. But something along the lines of, "I'm sorry, I know you would like to leave. But the doctor feels you are not safe to leave at this time, and you need to come into the hospital for further evaluation" is appropriate. Keep it simple and honest. Don't try to argue, reason or negotiate--simply state what is going to happen. But do answer any questions she may have.

Depending on her behavior, she may be offered or given medication to calm her down before transferring her to the psych unit. If she resists, security may have to get involved to get her over to psych.

Also, involuntary admission doesn't mean she can't refuse treatment after she's admitted to the psych unit. As long as she's not a danger to herself or others, she does retain that right to refuse meds, participate in groups and the like. If they want to force meds on her, she either has to be an imminent danger to herself/others, or there has to be a court order.

Hope this helps.

I forgot to add that when it comes to patients that are involuntarily admitted, the general idea is the same but each state may handle things differently. I spoke from the California point of view.

Goodbye and godspeed.

Just going to play devil's advocate here (since OP has already had their question answered) and say that there are likely many people you pass on the streets who are hallucinating and I would argue that if they are not a danger to themselves or anyone else and are coping well with their hallucinations/still able to function and take care of themselves, then yes they should absolutely be running around in public while hallucinating.

Indeed. If we were to keep everyone hospitalized until they were 100% hallucination free, we'd have inpatients staying for years. Some patients can be entirely rid of hallucinations. But others will have to settle for getting them controlled to a safely manageable point.