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Proven Techniques—That Work!

During therapy, a powerful technique used is often having the patient learn how to shift their perception, and be able to manipulate their understanding of their situation in a healthy way to ensure recovery, maintenance, and resilience against future decompensations.

Now consider this scenario: You have a mental illness—a psychotic episode where almost by definition you do not have control over your mind, or a recent suicide attempt brought on by a sense of overwhelming loss of control, or a debilitating anxiety or panic attack that makes it feel as if you have no control and are “losing your mind.”

Now think that you either go to the ED yourself because you recognize, on some level, you need help, or someone brings you to the ED because you are unable to recognize the level of help you need.

Both options can be terrifying, as EDs are busy, seemingly chaotic, very noisy, and bright places. They are suboptimal places for people without any pathology, and are even worse if you have a mind that needs healing.

If you, the patient, have had experience in the mental health system, you may know about involuntary holds and may be concerned that you may be placed on one when you go to the ED. If you do not and are told you are being placed on an involuntary hold, you also may become concerned. The common underlying theme is the loss of control, although in these instances, the loss of control, at least the loss of “freedom to leave,” is very real.

Often, EDs will have security officers dressed like police officers, or actual police officers. These security personnel may or may not be armed with tasers or even guns in the ED. The purpose of security in the areas where patients with psychiatric needs are being monitored, observed, boarded is one thing, and the way they are perceived by the patient is another. Uniforms are typically darker colored, look militaristic, and the officers are commonly larger and more muscular than the average person. While this is done on purpose to ensure the safety of the patients and staff, the intended effect is one of dominance and a “show of force.”

This does nothing other than further intimidate the patient in the ED, and creates a withdrawal from potential rapport building with the treatment team.

If your psychiatric issue involves anxiety, claustrophobia, paranoia, or persecutory delusions, your time in the ED is potentially made even more miserable, as you are now legally on a hold against your will, there are gigantic officers at your door restricting your ability to leave, hurt yourself, or anyone else, and you are “waiting for an inpatient psychiatric hospital bed to become available.”

The ED clinicians often are at the mercy of this wait for an inpatient psychiatric bed to become available, although at the end of their shifts, the clinicians get to go home. The patient has to continue to wait, and for psychiatric bed availability, the wait may be over after a day or two waiting in the ED, or sometimes even longer.

As real time updates are difficult, or practically impossible, to give to the patient, the reality of the loss of control can set in as the patient realizes they are unable to leave; and the unknown element of exactly when a transfer is expected compounds the anxiety, adds to agitation and may lead to acting out behaviors in the ED that may have been avoided or prevented had transparency in information been available.

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