What do you say? What do you NOT say? Mentally ill patients on a non-psyc unit...

[kristenncrn]

Hi all - I've been out of psyc for a long time and was writing an article about teen suicide and mood disorders. At the end, I was writing some of the practical tips for talking to kids with mental health issues that really helped me. Problem is - I can only remember some of the obvious ones (like avoiding "I know how you feel" and "it'll be better tomorrow" - both of which my colleagues have been heard to say!)

Can you guys throw out some of your best - and worst - lines? I work on a pediatric floor that is seeing more and more suicide attempts coupled with depression - but also some recent OCD, PTSD, bipolar disorder, borderlines - even a kid with conversion disorder! Not what most of my coworkers are used to seeing!

Thanks in advance for any thoughts!

Kristen:cheers:

[clearly_clara]

I am only a nursing student, but I'm taking my mental health practicum currently. It's a lil bit fresher in my mind. Hope the following helps! :)

When someone is talking about suicide, it's usually because they are experiencing so much psychological pain. So you can just reflect that back to them... "you must have been in so much pain to have wanted to do that." "That must have been so hard, for you to feel that." Just reflect the feeling back to them, or try to clarify what they're saying.

And be objective; use a nonjudgemental tone when talking to them about being depressed or suicidal. Just be accepting of what they tell you. And I guess, mostly, just listen to them. Usually psych patients just want to tell you their story.

[danu3]

You might want to scan the following classics (a good library should have it) and maybe you'll get some good ideas:

The Practical Art of Suicide Assessment: A Guide for Mental Health Professionals and Substance Abuse Counselers by Shawn Christopher Shea.

Psychiatric INterviewing: The Art of Understanding: A Practical Guide for psychiatrists, psychologists, counselors, social workers, nurses, and other mental health professionals by Shawn Christopher Shea (one of the sections deals with suicides).

[StuPer]

Hey Guys,

I work in the ED, or ER as you guys seem to call it, and usually have to deal with crisis scenarios, so communication is a big key. Generally I find, while yes it is important as to the content of what you say to a younger person, the way it is said is by far and away the most important.

How you tackle 'breaking the ice' is dependant on many things, actual age, diagnosis, current mood. If we say that the primary issue is depression/suicide, a younger person often feels there is a communication barrier with older people, that we 'don't understand'. Breaking down that barrier is I think the key to enable frank and open discussion about the younger persons feelings and hence risk factors.

Discovering interests, showing knowledge of and understanding of whatever is 'their thing' can help break that down. Talking to the young person on an equal basis at this stage can enable them to think you take them seroiusly and give an avenue into discussing the illness and hopefully disclosing risk situations.

Once a younger person 'trusts' you treatment becomes a whole lot easier...

I'm aware that this maybe teaching people to 'suck eggs', but that is unintentional, I just worry that a 'cheat sheet' of one liners, while helpful, may not always work. Invariably I find that if given sufficent time people of any age come to accept that you DO actually care and are interested in them as a person, at that point your onto a winner

StuPer

[Louisernc]

First of all, bless you for caring and for trying to reach out to your troubled patients. As a nurse with over 20 yrs experience in Psych nursing, I find there are not enough nurses like you. The previous replies are great advice. My thought was that there are probably other staff on your unit and throughout the hospital that would benefit from an inservice on what to say, and how and when to say it, to the patient as well as the family, who, no doubt, will also be in crisis. Remember that emotional pain should be regarded like physical pain and based on the patients perception and subjective reporting. It doesn't matter if we think it is foolish to swallow a bottle of pills after the break up of a "puppy love" relationship; to the teenage girl who took the pills, the pain was off the charts.