I'm a counselor (chemical dependency and pastoral), not a nurse,
but this subject really interests me, so I jumped on board and offered to assist with putting some things together.
I am not a medical professional, I will stick to what I know and quote from (or link to) reputable medical sources when venturing
out of that realm. If you have an area of expertise, please chime in with anything I might have missed -- this is a work in
progress. Also, if you have any questions, please feel free to ask them. I check this forum daily, and will do my best to
get you an accurate and timely answer.
The basic outline I plan to cover, at least as I envision it now, looks like
Mental health during crises
Overview of common mental health disorders
of psychiatric medication, by condition
Alternatives to medication: herbs, lifestyle, spiritual care, counseling, etc.
about if/when the meds run out?
Overview of common chemical and behavioral addictions
Treatment of addictive disorders
considerations with addiction: securing meds, withdrawal, etc.
If there is something else that you would like covered,
just let me know.
Resource links will be posted periodically, accompanying the Q&A or related subject matter.
The information you receive from me in this course is not counseling or medical advice. You should consult your doctor or
medical practitioner before beginning (or altering any established) medical treatment.]
Depending on the type
of crisis event (war, natural disaster, terrorism, SHTF scenario, etc.) the type of psychiatric emergencies you may encounter
will be varied. For the sake of this discussion, we will define "psychiatric emergency" as something that must be dealt with
IMMEDIATELY and something that takes PRECEDENCE over other activities in which you may be involved. Some examples of psychiatric
emergencies are combative patients and homicidal/suicidal/violent people in your unit or group. Ideally, a psychiatrist should
be the one treating psychiatric emergencies. In lieu of a psychiatrist, a doctor is preferred, then any other medical or mental
health professional. As with any emergency, you might be the first one on the scene, and while this material covers the basics,
it is by no means all-inclusive. Read up on psychiatric conditions and their treatment. It might just save your life or the
life of someone you know, even now.
The primary task is to ensure your own safety and the safety of those around you,
as well as the safety of the patient. Remove their weapon if they are armed, and secure other weapons (and things that could
be used as weapons -- take it from me, getting stabbed with a pen or a fork hurts!). This may require the use of manual restraint
(holding the person until they calm down) or physical restraint (tying them down). In the US, we are, understandably, very
concerned about liability and there are lots of rules about when and how this can be done. Use your head or you will get your
pants sued off. In a SHTF scenario, do what you have to do, but you should still be able to explain why you did what you did.
When you have a chance, document what happened. If you have the resources and skill, medication may also be in order (Ativan,
Haldol, and Geodon are all good options, according to the Merck Manual for Healthcare Professionals).
http://www.merck.com/mmpe/sec15/ch195/ch195d.htmlIt is important to note that if a wide-spread disaster or SHTF
event occurs, medication may not be readily available, meaning that psychiatry (and the practice of medicine) as we know it
will be radically different.
If the person is physically restrained it is important to monitor them closely. “Hospital
accreditation standards now require that patients in restraints be continuously observed by a trained sitter. Immediately
after restraints have been applied, the patient must be monitored for signs of injury; circulation and range of motion; nutrition
and hydration; vital signs, hygiene, and elimination; physical and mental comfort; and readiness for discontinuation of restraints
as appropriate. These assessments should be performed every 15 min.”(Merck) Even if you aren’t in a hospital,
it’s good to check for these things. I imagine that even perfectly sane people can become quite hostile if they can’t
move, they are lying in their own filth, and their legs are turning blue from lack of circulation.
As the person becomes
more stable, it is important to continue to evaluate their mental status and intent to harm themselves or others.
http://www.merck.com/mmpe/sec15/ch195/ch195b.htmlhttp://www.merck.com/mmpe/sec16/ch20....html#BDEEDDGGAssess the situation to find out the cause of the bizarre or
violent behavior. Interview the patient (once they calm down) as well as the patient’s family. What are the situational
stressors that he is facing? Is he drinking or using drugs? Any history (or family history) of mental illness? Are there any
medical conditions that could be contributing to the problem? What can the family or unit/group do to help keep him stable?
Is there a counselor or minister he can talk to?
http://www.psychiatryonline.com/prac...ChapToc_1.aspxIf medication is available, it might be wise to release the
patient with some medication to increase stability upon release, but as many psychiatric medications take weeks to build up
to a therapeutic level in the body, and medication supplies may even be limited, this may prove impractical. In any case,
it is necessary to develop a safety plan upon discharge (a family member or friend to supervise the patient, followup care,
self-care recommendations, etc.). We will explore phytopharmacologic and other non-medical therapeutic options later in the