Seeking Mental Health Help in an Emergency

In the not so distant past, a huge stigma existed for people who lived with mental illnesses. Fortunately today, we are much more open in regards to this facet of health care, but there are still questions that arise regarding the diagnosis, resources and treatment of these diseases. Below are some common questions heard today, and hopefully some answers to help you or someone you love

How prevalent are mental illnesses?

Mental illnesses are much more common than we realize. Nationwide today, nearly one out of every four people lives with a mental illness. This can range from anxiety, depression, schizophrenia, obsessive-compulsive disorders, bipolar disorder, and forms of autism and attention deficit disorder. Stand in line at the grocery store, work in a small office or head out to the park, and you can bet someone you bump elbows with is currently being treated, or should be treated, for a mental illness.

What causes mental illnesses?

Despite tons of research currently going on, we do not know the exact cause of most mental illnesses. What we do know, and what is becoming clear through research, is that many of these conditions are caused by a combination of biological, psychological, and environmental factors. Genetics may play a role, the chemical composition in our brain definitely is a potential source, and even our immune system has been noted to have an impact. Our DNA, our background, our personality type and the influential people in our lives can all combine together to increase the susceptibility of a person to develop a mental illness, and by the same token, diminish the risk as well.

The access points for patients receiving treatment is varied. Many times, patients will go to their primary care physician with mental health questions seeking treatment, and are either directly addressed by the physician themselves, or referred to a specialist. Emergency departments also serve on the front lines for mental health care. Many evaluations take place that will determine how we can best help them while they’re in our care, as well as once they leave the hospital.

What services are available for people living with mental health illnesses?

Courses of treatment include medications for chemical disorders, psychotherapy (counseling by a licensed psychiatrist and their staff), and group therapy. There generally are 3 stages of care:

Outpatient treatment: This is done through a physician office or counseling office, where care is rendered during scheduled appointments. The patient can continue working, caring for their family, and their usual activities during this type of treatment.

Partial Hospitalization: This is sometimes called ‘Daytime Hospitalization’, where the patient spends several hours each day in an organized program, but can return to their own home for the evening and nighttime hours. This is a wonderful option for those patients who are stable, but require more intensified help.

Full Hospitalization: Hospitalization on a hospital unit that specializes in mental disorders is left for those who need monitored help and are a risk to themselves and others if they remain unsupervised. It creates a perfect venue of counseling, group therapy and the ability to adjust medications while observing firsthand the results to ensure positive improvement.

What level of care should I seek?

Just like any other chronic illness, mental health disorders require constant monitoring by a physician specializing in the various treatment options. Regular appointments with your psychiatrist should be kept for routine visits or anytime you are noticing changes in your symptoms (e.g., not handling stress well, inability to concentrate, crying all the time). Often the people around us have a more objective view of our behavior, so if a friend or family suggest you may need to follow up with your physician, consider setting up an appointment.

Emergency treatment (in an emergency department) should be sought anytime you can no longer function, can no longer handle stress or have any thoughts of hurting yourself or others. Do not delay treatment in these cases, as management of medications and therapy is needed.

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What role do emergency departments play when someone arrives at the emergency department seeking help?

If a patient is a harm to themselves or to others, they create a clear and present danger to life. These people are hospitalized, either through voluntary admission, or we mandate hospitalization. We cannot let them go home except in rare instances when someone is with them all the time and takes responsibility for them. If we send someone home we know is suicidal or homicidal and they harm themselves or others, we are liable. During hospitalization, we use a combination of medications, counseling and group therapy to treat the patient and stabilize them. Following discharge, they are set up with a psychiatrist for frequent checks to ensure improvement of condition.

If the patient seen is not suicidal or homicidal, they most likely will be treated with medications and outpatient treatment, either partial hospitalization or follow up in a psychiatrist’s office.

What kind of help is available right away to someone visiting an emergency department?

It is not a problem if someone does not have a regular psychiatrist. Psychiatrists can be “on call” just like other physicians. So, if a patient presents with thoughts of harming themselves or others, we contact the on call psychiatrist. They will then take over their care, and most likely follow them into the outpatient arena once the patient is discharged from the hospital. If the patient is not suicidal or homicidal, they are started on medications in the ER if necessary, and then referral numbers are given to the patient so they can follow up and continue treatment. Often we contact these psychiatrists and let them know that the patient will be following up with them so they are expecting their phone call.

We have come a long way in the treatment of mental health disorders. This is evidenced by the large number of individuals who are currently under treatment for their condition. We still have a long way to go to ensure that everyone with a mental illness can be the very best they can be.

Diane SimonDiane Simon, RN, CEN, is the Trauma Coordinator/Registrar for ProMedica Defiance Regional Hospital.