What to do with a head banger?

[djules]

My facility is small (100 inmates) and I am the only medical staff. I have come across this situation a couple times and am at a loss. I have an inmate who is banging their head on the wall.

Situation #1 Imate is having a mental breakdown (mania, schizo,...). The local hospital will not admit MH inmates with charges pending. Crisis center has a wait list for a bed. Medications are not working.

Situation #2 Inmate is upset about being incarcerated and wants to go to the hospital. Pure manipultion.

We do not a a restraint chair. We do not have 24 hour medical coverage. Usually with Situation #2 I explain that they will not be transfered to the hospital. I keep an eye on them but out of their line of site. Usually this tactic works and after awhile they get to tired, to sore, or to bored to continue.

Situation #1 is much more frustrating. Sometimes you just cannot reason with them. Aside from a officer blocking the inmate from continued harm there has not been much I can think of to protect the inmate.

I cant change the facility. I cant hire more medical. I cant get the hospital to cooperate.

Anyone out there who has found themselves in the same situation and found a tactic that has worked (at least sometime) I would love to hear your suggestions.

Thanks.

[ILoveHealthCare]

Do you have a padded cell? We use that. It's kind of like punishment because there is no toilet, just a hole in the ground. It's the same cell we use for suicide watches. We have medical coverage 24 hours a day and use the restraint chair if we have to. We usually try to avoid it though.

It's a beautiful day to save lives.

[Revvy1337]

You now have the evidence visually to move them to suicide watch since they are "hurting themselves." If they are manipulating the system the person will stop right away in suicide watch so you kind of know and then you can say back to general population for you!

[avahnel, ASN, RN]

Can your facility aquire a foam helmet? We have used them at our facility when there seemed to be no other option. At least them you can chart that it was applied, and you tried to protect the patient's head from self-injury. Good luck!!

Something like this

Soft Comfy Cap | Helmets & Head Supports | e-Special Needs

[Orca, ADN, ASN, RN]

In an instance like this, we use restraints to prevent self harm. However, this requires 24-hour medical coverage, as you cannot leave an inmate restrained with no medical oversight.

[gesundheitz]

1. Probably not gonna really harm himself. Head banging is a self- regulating behavior.

2. Awesome, fuggly, peach colored padded helmets. It has cured many head bangers and pseudo seizures.

[Giveback]

We bought him a helmet but he took it off. Restraints weren't justified. The only thing that worked was handcuffing him to the bench in booking until the moments passed. he physically couD not bang his head on anything! (Our facility is around 100 also).

[Truegem]

The hospital will not admit MH patients with charges pending, but will they see them in the ER? They can really cause damage to themselves! Our policy is to send them out for clearance for mental health housing if they are banging their head. They might even give them some medication, so when they come back, they are calmed down.

[42pines]

Long before I was an RN I was a caretaker for various clients (we never called them patients). These people had their own house, and were cared for 24/7.

There were some funny stories like the guy who decided that he needed to smash plates.

"I'm angry, when I get home I'm going to smash my plates."

Me: "That's odd, if you smash your plates how will you eat?"

"I have lot's of plates."

Me: "Really, like how many."

"5 boxes of them."

Me: "Will you wear safety glasses and break them outdoors so it will be safe."

"yes." (note: He actually did have 5 boxes of plates of all sorts--cheap plates like from tag sales)

Well, he broke half a dozen plates, safely and then cleaned them up and he never, ever forgot that, even though more than a decade has passed. Naturally I got raked over the coals: "That's no way to deal with anger?" Well, looking back, yes it was. It empowered the fella. I'd do it again.

Another client: The headbanger.

Severe Phenylketonuria (PKU) a genetic disorder that is not usually a problem in America because all infants are tested and treated. But this client was never treated and suffered severe brain damage. The client had already blinded him/her (I'm not saying) self in one eye due to head banging. In this case it was fist smashed into head--hard, and I mean hard. Full force. Worse than banging a head on a wall (maybe).

The headbanging came on quickly, lasted for about 5 minutes and then stopped. Being clever and fast I thought I could at least place my hand between fist and head and cushion the blow but I was told that was restraint and could not do that. Also the head banging clearly served a purpose.

I noticed that sometimes hair pulling seemed a satisfactory substitute so I'd take the fist, gently open it and put hair in it. The client would then pull hair, but never pull it out. That worked, the hair pulling clearly served some purpose. But: "Sorry...that is restraint." It was too terrible to witness.

I quit.

In your case OP I can appreciate that it's a terrible place to be, just to witness such behavior. I'm sure you've tried talking and substituting hair pulling in this case won't work so option one is to "let it be." Option two: Quit. I wish I could offer more but can't.

[Pudnluv, ASN, RN]

I know in our ER we have had inmates come in due to mental health issues. If they are having a psychotic break, this is a mental health emergency and should be evaluated by a medical professional. There have also been a couple of times we have had to admit these patients to our mental health ward to get their medications under control. When they are discharge, the sheriff is called and they are escorted back to the jail.

If you are truly concerned about the headbanger, send him out. Say you want him evaluated for a head injury (which is reasonable). When he gets to the ED, they will medicate him and/or restrain him. Once he has calmed down, he will be sent back. At least this will take the burden off you, especially if he has the potential to seriously injure himself.