Learn More. Or in a crisis , text "NAMI" to Donate Now. If a situation escalates into a crisis, you may have to call the police. Thankfully, there are a few things you can do to keep the situation as calm as possible. Share all the information you can with your operator. If the police who arrive aren't aware that a mental health crisis is occurring, they cannot handle the situation appropriately.
Many communities have crisis intervention team CIT programs that train police officers to handle and respond safely to psychiatric crisis calls.
Police are trained to maintain control and ensure safety. If you are worried about a police officer overreacting, the best way to ensure a safe outcome is to stay calm. When an officer arrives at your home, say "this is a mental health crisis. Yelling or getting too close to the officer is likely to make him feel out of control. Are you, or someone you know, experiencing suicidal thoughts? Call If you or someone you know is in a life threatening emergency or in immediate danger of harming themselves.
Use your coping skills. Examples might be: Relaxation techniques Exercise Deep breathing. Find distractions Go for a bike ride or a walk Watch you favorite TV show or movie Go to your favorite place or store.
Make your environment safe Ask a friend or loved one to store your medications and firearms Lock up medications and firearms. If you are thinking about harming yourself or attempting suicide, thinking about harming someone else, experiencing severe emotional or behavioral distress, feeling out of touch with reality or disoriented, feeling out of control, or experiencing an inability to care for yourself, seek help right away: Call your medical doctor or your mental health provider.
Call for emergency services. Go to the nearest hospital emergency room. This is not a replacement for calling Hours of waiting in mental misery may only confirm the patient's feelings of hopelessness and abandonment, thereby increasing suicide risk. A suicidal patient with agitated depression or a psychotic patient with auditoryhallucinations that command suicide may leave the ED before being seenand attempt or complete suicide.
Psychiatric emergency services PESs , staffed by psychiatrists and a full complement of other mental health professionals, are usually based at large medical centers or universities. They are open 24 hours a day, 7 days a week, andprovide "full service" comprehensive emergency psychiatric services. Generally, a phone call to the patient by the psychiatrist is an intermediary step to determine an initial course of action. The psychiatrist may be able to assess the severity of a patient's suicidal crisis over the phone and, if necessary, arrange an emergency appointment.
If possible, the patient may be managed by means other than referral to the ED. A return call from the psychiatrist can stabilize a suicidal patient until he or she can be seen on the same ornext day. Thus, the therapeutic alliance is preserved and strengthened. It may be necessary to send a suicidal patient in need of immediate care to the ED or the patient may go to the ED without calling the psychiatrist. In the first instance, the psychiatrist should determine whether the patient is able to go to the ED alone or needs someone to take them.
Clinicians have escorted patients to the ED. The suicidal patient may be so disturbed that he is unable to come to the psychiatrist's office or to speak coherently on the phone.
The psychiatrist should try toenlist the assistance of others eg, a family member, partner, friend, or the police before sending the patient to the ED. If none are available, the psychiatrist may have no recourse but to call or community crisis management services. A phone call to the PES or general hospital ED in advance of the patient's arrival will alert and inform the staff about the suicidalpatient. It also may help decrease the waiting time in the ED. The psychiatrist or the covering clinician who should be informed about suicidal patients who might call must be available to respond within a reasonable period.
Although hard-and-fast rules do not exist, if possible, an emergency call from a suicidal patient should be responded to within the hour. Cell phones facilitate accessibility and rapid response. For a patient in a suicide crisis, evenwaiting an hour may seem like an eternity. In solo practice, the psychiatrist or covering clinician must be accessible to calls from suicidal patients 24 hours a day, 7 days a week, by cell phone, pager, or other means of direct communication excluding e-mail.
Twenty-four-hour coverage for patient emergencies is an established medical practice and standard of care. Psychiatrists in group practice or institutional settings have on-call schedules that provide continuous coverage for patients. Some psychiatrists provide their home phone number to patients during a period of increased suicide risk. Question: One of our members is concerned that psychiatrists in his area do not routinely check in with their answering machines after hours, leave no number where they may be reached, or leave a message for patients to contact the local emergency department in case of emergency.
Is this member's concern about the ethics of these psychiatrists warranted? Answer: Yes. Ethical psychiatrists are obliged to render competent care to their patients. That competent care would include either being available for emergencies at all times or making appropriate arrangements. Certainly, a message telling patients to call an emergency department is not adequate coverage.
Even in rather stable practices, including analytic practices with relatively stable patients, emergencies do arise. Care must be taken that, if and when such emergencies do arise, the patient is not abandoned.
With the current limitations on access to hospital services, most patients at risk for suicide, even long-term high-risk patients, are treated as outpatients.
Some psychiatrists provide and discuss with new patients a safety protocol to be followed in an emergency. The spirit of the discussion is, "We're in it together.
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