Emergency Mental Healthcare. Daniel Giers, MA, LPC, QMHP
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1 Emergency Mental Healthcare Daniel Giers, MA, LPC, QMHP
2 Topics Introduction Description of crisis work Process of crisis and dispositions Process of hospitalization DSM/disorders Challenges in crisis work Summary/questions
3 Personal Introduction Education history AS in Nuclear Weapons Technology (CC of the Air Force) 2006 BA in Liberal Arts (Excelsior College) 2010 Psychology Major MA in Clinical Psychology (Chicago School of Professional Psychology) 2012 Specialization in PTSD Masters of Business Administration (Southern Illinois University) 2016 Specialization in Healthcare Management
4 Personal Introduction Work and Internship History Superior Ambulance (Emergency Medical Technician) United States Air Force (Nuclear Weapons Specialist) Chicago School of Professional Psychology (Teaching Assistant) Associates in Behavioral Sciences (Therapy Extern) Holy Cross Hospital (Crisis Extern) Pro Ambulance (Dispatcher) Community Elements 2014 Current (Crisis Clinician II) Presence Covenant Medical Center / Carle Foundation Hospital
5 Crisis Clinician I and II Crisis Clinician I Requires BA/BS in Behavioral Sciences (Psych/BSW) Crisis Clinician II Requires MA/MS in Behavioral Sciences (Clinical Psych/Psych/MSW/LSW/LPC/LCPC/LCSW) Contracted to local hospitals Respond to contracted hospitals for crisis assessment and disposition Rapid DSM diagnosis and MMSE Complete disposition and hospitalization if needed
6 Crisis Process - Assessment Client s story Harm to self/others/imminent risk/self-advocacy Psychosis Current mental status/mmse Current and past use of services including hospitalization Medical history and family mental health history Living situation/employment Substance use/abuse/dependence
7 Mental Status MMSE Alertness and Orientation and AO x 1 (person), 2 (place), 3 (time), 4 (situation) Thought content/reality testing (internal response/hallucination) Speech rate/tone/clarity Mood/Affect/Level of cooperation Memory (immediate/short/long) Hygiene/Grooming Attention Psychomotor agitation/grooming
8 Emergency Procedure Physical restraint 4 point 5 point with chest Lap with chair Chemical restraint (ordered only by MD/DO/PA/NP) Haldol mania/psychosis Ativan anxiety (typically coupled with Haldol) Geodon mania/psychosis Zyprexa PO mania/psychosis Ketamine sedation (always monitor airway and circulation)
9 Potential Dispositions Discharge Must have safety plan and follow up instructions Step Down Must not prevent a safety or elopement hazard Hospitalization State hospitalization (McFarland for Central Illinois) Madden/Reed/Elgin/Alton/Choate Medical admission Decided by MD/DO/PA/NP/Hospitalist Residential substance treatment/detox Voluntary program only Nursing home Consider power of attorney
10 Reasons to Hospitalize Suicidal Imminent danger (look for plan, means, threat and history) Gesture vs Attempt Homicidal Imminent danger (look for plan, means, threat and target) Intent to harm notification (police and target) Acute psychosis Delusion, hallucination, paranoid ideation, bizarre/abnormal/manic behavior Hallucination (auditory, visual, command, tactile, touch, and olfactory) Inability to care for self Extent must be extreme
11 Types of admission Voluntary Client is agreeing to be voluntary hospitalized in a psychiatric facility Voluntary form must be signed AFTER admission is accepted Involuntary Client s rights are being removed (less desirable) Pose an imminent danger to themselves/others Unable to adequately care for self Petition/certificate/USARF Medical Admitted for medical reasons found during assessment Must be determined by medical staff only (MD/DO/NP/PA/Hospitalist etc.)
12 Involuntary Admission - Forms Petition - Petition Can be filled by any adult (typically police or crisis worker) Cannot be filed on a minor Certificate - Certificate Must be HAND FILLED by MD/DO only Time on certificate MUST be after time of petition USARF (state facility) - USARF For admission to state facility In some cases, for use in SASS/Medicaid cases (Chicago)
13 DSM Typical Disorders Assessed Mood disorders Bipolar/MDD/Mood NOS Thought disorders Schizophrenia/Schizoaffective/Psychotic NOS Adjustment disorder* MUST have an Axis I dx for assessment to be accepted Personality disorders Borderline/Antisocial/PD NOS Anxiety spectrum PTSD/ASD/GAD/Panic DO Substance-related disorders
14 Challenges Faced During Hospitalization V65.2 Malingering Manipulation/homelessness V15.81 Noncompliance with treatment V61.21 Abuse/neglect of child (DCFS report mandatory) BIF/MR Hospitals must be set up for decreased functioning Dementia Consider medical admission/nh/assisted living Psychosis/Mood related to substance abuse Involuntary admission with open criminal history** Criminal law supersedes civil law
15 Challenges Faced By Crisis Staff Medical Staff Lack of specialization/recognition of crisis Family/Friends Lack of understanding of law/over-emotional state Secondary trauma/secondary gain Law Enforcement Weak/improper petitions/admissions Personal Stressors/Secondary Trauma of Clinician Always support self care
16 Conclusion Mental illness is nothing to be ashamed of, but stigma and bias shames us all Bill Clinton (42 nd President of the United States) Questions?
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