Too many mentally ill patients admitted?

[ed.hall]

Hi, i'm actually a nurse from Sydney, Australia. I was just wondering what you lot thought of the state of community mental health over there?

Here in Aus we used have a lot more mental health in-patient facilities, however a shift in health policy shut a lot of these down in favour of caring for these patients in the community.

I have friends who work in Emergency Departments and they complain that sometimes the majority of their shift is taken up looking after mentally ill patients because there are limited readily available inpatient psychiatric beds to accomadate them. Compounding that, they remark that if the patient hadn't been released back into the community earlier than was safe then they would have had more of a chance of fully stabilising their mental state whilst being an inpatient.

Is your situation different from state to state? Do you think you have similar problems as here in Aus?

Or do you think that most healthcare facilities are stretched anyway due to increased population and limited resources?

I'm not quite sure personally but I thin, over here at least, these issues need to be adressed soon...

[al7139, ASN, RN]

Hi,

I agree with you. As a cardiac nurse, I primarily treat patients with heart related conditions. BUT I also get the suicide attempts, ETOH withdrawals, and general psych patients which range from drug seeking to serious problems like schizophrenia. I work in a hospital with no psych ward, and we do not get alot of training as to how to treat these patients. Our docs do order psych consults, but I feel lots of times these patients are put to the side, and our psychiatrists send them home without proper diagnosis or treatment as long as they "walk the walk and talk the talk" even if they really need intensive help. It is really sad to see a patient get discharged that cannot function in normal society because noone wants to take the time to find them shelter, medical treatment, psych treatment, and therapy because it takes a little more work. we get patients who linger with us, getting NO therapy because a bed in a psych hospital is not available, or they just get discharged to the same miserable life they came in with. I don't know how this helps the patients.

I am NOT a psych nurse, but I see every day these patients, and I hate it, because we could do so much more.

Amy

[ed.hall]

Thanks, what you say is very interesting, do you think this a problem of lack of time and resources whilst they are on your ward? Or is the US health system more inclined to treat psychiatric patients in the community rather than as in-patients? I know as nurses we need to acquire skills all the time but unless we are psychiatrically trained there is only so much a cardiac nurse/docter can achieve i suppose...

[bellasage]

I do woman's services and the occasional Med/Surge... They all seem a little mentally ill to me.

[Penguin67]

In the State of Georgia, there are fewer and fewer facilities that care for patients with psych issues. When there is a budget crunch, as there currently is, psych facilities are usually looked at and funding is cut. It is all over the state here. Working peds, I have had children who were on suicide precautions, so a PCT had to be at the bedside all day long, which took the PCT off the floor helping the nurses, which just doubles the nurse's work. Certainly not the way it should be. And it will most likely get worse, as ther aer several facilities that will probably close, thereby putting the pressure on the existing facilities to care for the psych patients. Unfortunately, the problem that you described is jsut as common here in the states.

[ed.hall]

That sounds very similar to our experiences, what's a PCT by the way?? Its a shame they look to the psych units first when cutting budgets, you'd think it was essential in any society

[Katnip, RN]

I currently work in a psych facility. I've worked in ER and am going back to it in a few weeks.

There are not enough psych beds. Here, ER staff, especially the docs hate treating mentally ill pts in the ER, sometimes to the point of totally ignoring their medical issues like diabetes.

Nobody holds psych patients in patient for long enough. Our facility is a pretty good one, but we will discharge to home, the community-based resources, shelters, or state beds. The state keeps them a few days and releases them. They wind up with us, we send them back and it just becomes a revolving door for both places.

The idea that the mentally ill are treated properly in the community-which is why a lot of facilities were shut down decades ago-is a joke. There are not enough places, not enough money, and nobody wants to take care of these folks. The patients themselves can't get their meds or don't want to take them.

It really breaks my heart sometimes. We get so many who come here, get stablized and a month or two later wind up back with us. Mostly because there just is not enough support for them in the community and they really can't take care of themselves.

[Katnip, RN]

That sounds very similar to our experiences, what's a PCT by the way?? Its a shame they look to the psych units first when cutting budgets, you'd think it was essential in any society

A PCT is a "patient care tech" or sometimes Psychiatric care tech. They're like nurse's aides but can often perform more skills than ADLs.