Vent about psych admit of 12 yo boy

[elizabeth8503RN]

***VENT*** ***Kind of long***

I work in an equivilant to a pysch ER, we do assessments, then reccommend the patient to the correct level of care (therapist, psyciatrist, in-patient, ect...)

Anyways.... I did an assessment on a 12 yr old boy, accompanied by his bio mom and her boyfriend. The boy was making threats to hurt himself, cut his throat, ect. Very defiant, rude, obnoxious, continued to deny that he was ever suicidal, not very cooperative.

After the assessment I called our on call doctor (per protocal) and it was reccommended that this boy go to either day program (if parents felt safe taking him home), or in-patient on our unit.

I go back to the assessment room to inform the boy and his mother of the decision. I basically say "Ok...I talked with our doctor on call, and we have two options. 1. (talking to the boy) You can go to day hospital, or 2, you can go in-patient."

The immediate response from the boy was "My mom has a third option. She can just take me home. I am not ever coming back here. I don't have to!"

I inform mom that yes, that is an option, but we also have a fourth option, mom and mom's bf could file for commitment. The three of them begin to discuss this, and it became heated. I opted to leave the room so that the three of them could discuss the options.

While I was waiting, I noticed the boy attemting to leave the premisis, with mom yelling at him to come back. Luckily he did go back to the room, and our security guard had to stand by to help monitor him. I go back to the room and mom tells me that she wants me to start filing for court committal.

I go back to the nurses station to page our doctor yet again. Not five minutes pass, and I am called back into the room, yet again. Mom has decided that she will take him home, AMA. I let her know that before we can go that route, the doctor must be informed.

Get a hold of the doctor, and the doctor reluctantly agrees to do this. Go back to the room, have them sign AMA. They leave.

NEXT DAY

I get a frantic call from the same mom about the same boy. He went to school and made threats that he wanted to die. She was headed over to the school to pick him up and bring him there. I inform her that if she wants to bring him in, and he was unwilling to come voluentarily, that they (mom and mom's bf) needed to go to the clerk of courts office and have him committed.

Few hours later they stroll in with the court committment papers... and he is promptly admitted (be me).

The entire time the boy is abrasive, rude, and continues to deny any suicidal ideations, he claims that what he said at school was "This (who knows what "this" means) is what makes me feel like killing myself."

Anyways, he is admitted to the unit, and mom still isn't sure that she wants him there. (AFTER obtaning the court order)

Some days I just don't understand people.

[elizabeth8503RN, MSN, EMT-B, NP]

OP, I think you did a good job given the circumstances. So you are the primary screener with input from the psychiatrist? Interesting.

Thank you...and yes... that is how it works at our facility, and it seems to work very well. Once our initial assessment is done, if needed we call the psychiatrist, then make our recommendation. If we feel at all ify in regards to the patient, the situation, anything, our pyschiatrist is called. If we are concerned about the medical stability of the patient, we send them off to the (medical) emergency room.

[klone, MSN, RN]

I probably spent more time on psych units as an adolescent than off of them. I had an unstable home life but most of my issues weren't really environmental. (I'm one of ten kids and none of my other siblings had the same issues that I did.)

From the perspective of a former patient, I think I would interpret the boy's "this" statement as both a lack of control and a lack of those in power correctly interpreting whatever is going on in his head/thought patterns/etc. And, yes, the third option means that he has half a brain. I said the same stuff all the time.

For what it's worth, I spent a lot of time IP but my mom absolutely refused to let me go residential. As a foster parent, she "knew what kind of kids went to those sorts of places" and, in hindsight, probably didn't want to let go of whatever authority she had over me. At one point, I was a 70 lb anorexic whose self-injury issues were landing her in the ER 2-3x a week. I desperately needed long-term treatment but my mom continued to refuse.

I turned out okay, I guess. So it does happen. But I'm pretty sure that most of my treatment providers would have had the same questions about my mom that you do about the boy's family.

I could have written a lot of this.

My sympathy doesn't really reside with the OP, who gets to go home and brush this aside. My sympathy is with the kid.