lifestyle issues
Schizophrenia: The Disease
What It's Like to Suffer From Schizophrenia
John's Story: Part Three
As a consequence of their concerns, social services professionals outlined the process for involuntarily assessment and commitment. In most places around the country, mental health professionals and police can transport an individual to a hospital for further evaluation if they suspect that the person is in danger. This danger is generally defined as perceiving that they are a risk to themselves or others. If they have demonstrated that they are unable to adequately care for themselves, this constitutes a risk to themselves.
An in depth assessment is usually not required to establish that risk, but only sufficient reason to believe that the person is at some risk. The laws that govern these situations are, by their design, simple and relaxed. This allows police or other interested parties to err on the side of being conservative. These laws streamline the process of offering and providing protection and assistance, even when people afflicted with Schizophrenia are unwilling to obtain this assistance on their own.
In this case, John and his family were fortunate. Professionals from social services were able to visit John that same day and John allowed them to come inside and interview him. In spite of his condition, John retained the ability for some rational thinking. When they explained that the police could be involved, John agreed to visit the emergency department of a local hospital with his family.
The social workers assessed John’s risk for suicide or for acting out in some other dangerous way based upon his irrational thoughts. They believed that it was safe for him to go with his family. Had they been uncertain, they could have contacted the police for assistance.
This option involves the possibility that psychotic individuals, especially those with paranoid thoughts, will become more agitated, but it is sometimes the only safe way to guarantee that a person is safe and gets the help they need.
John actually seemed relieved that some of these decisions were being made for him. He still had enough insight to know that what he had been thinking and doing was no longer helpful. No matter how disturbed our thinking may be when we have psychotic thoughts, we are often capable of some rational thinking. Not all people with psychosis have that presence of mind. Some must be taken to the hospital by police.
The social workers who interviewed John contacted the hospital to share what they knew about John’s current level of symptoms and the history of his illness in recent weeks. This allowed the hospital to prepare for John’s arrival. John was able to go directly to a quiet room with minimal stimulation where they could immediately ensure that he was warm and comfortable. They provided juice and offered John something to eat.
These measures, and the fact that John’s family and Melody were allowed to be with him, helped to foster trust between John and the hospital staff. Since it is common for people with acute symptoms of psychosis to present to the Emergency Department of a hospital, the staff there have a great deal of experience dealing with these symptoms. They will usually attempt to streamline the process so that things happen quickly, while patients are still receptive to evaluation and treatment.
The best emergency department nurses and doctors are highly skilled in their ability to present themselves as non-threatening compassionate individuals. They are able to effectively demonstrate that they care about the patient and are there to help. They are focused on relieving whatever uncomfortable symptoms patients have, so long as this does not interfere with the assessment process.
John was offered a medication called lorazepam, a very safe medication that is widely used in hospitals to calm anxious or agitated patients. It is not designed to make them sleep, but it may allow them to rest if they are exhausted and have been deprived adequate sleep by disturbing symptoms.
The expected beneficial effects and possible side effects were carefully explained to John. He was offered a range of safe doses of this medication. This allowed him to play an active role in his treatment, should he be comfortable enough to try the medication. He was also offered the options of taking the medication as a pill or as an injection in his upper arm. Receiving lorazepam as an injection in the muscle of our arm allows the medication to work much faster. John was comfortable enough to agree to a medium dose administered as an injection.
John also allowed the emergency physician to examine him and consented to laboratory tests that included routine blood work, a urinalysis, and a urine test to rule out the presence of drugs that might be causing or worsening his psychosis. As a precaution, these tests included screening for drugs that might have been taken as an accidental or intentional overdose. Had John been a female, they would have included a pregnancy test before John was offered any medication. Since John recently had both CAT and MRI scans of the brain and there was no evidence of new trauma, these were not repeated.
After completing a careful evaluation, the emergency room doctor recommended that John enter the hospital voluntarily for observation. He also discussed John’s suspiciousness and fearfulness and offered medication that could more specifically target those symptoms. As had been the case with the lorazepam, expected benefits and possible side effects of this medication were reviewed for John and his family.
(Sources: The author's knowledge base, unless otherwise noted.)
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