>>Emergency holds enables people to get mental health evaluations and treatment

I was walking back to my desk from seeing another patient in the Emergency Department (ED) when I saw the police walk in with a very well-dressed young man who was tearful and seemed very out of place. While he was cooperative with the police officer who was escorting him, he repeatedly cried out that he needed to leave and that they needed to let him go.

The police took the patient to his room in the ED and advised the nurse that they had put him on a “pink slip,” which is what we call the paperwork used to detain an individual for the purpose of emergency evaluation and hospitalization for a specified amount of time.

The officer with John said that police were called by a store manager because John had been hanging out at the store’s back dock and told workers that he was there to check the store for poisons that were being sent in by a group of bad people. They ignored him the first day and figured he would leave, but when he wouldn’t leave the second day and started to show signs of agitation and pressured speech, they called 911.

Certain professionals, including police and paramedics, can bring an individual to the ED against their will if they have a reason to believe a person is mentally ill and has a substantial risk of physical harm to themselves or others. It allows us to “hold” a patient who is presumed to have a psychiatric illness, is under the influence of drugs or alcohol, is suicidal or homicidal, or is unable to care for themselves due to a mental illness. This hold exists to ensure the evaluation of a patient where we have concerns about their well-being, or the well-being of others, even if the patient does not want that evaluation.

I went in to see John shortly after he arrived as he was very upset that he was not able to leave the ED. As I walked to his room, I saw him pacing in and out of his room and he was speaking very rapidly. I introduced myself to him and asked him to sit down. He reluctantly sat on the edge of the bed and asked me when he could leave. He was rapidly tapping his toe against the floor. He told me that he had to get back to the store to continue monitoring for poisons. He said his boss would be very upset that he was not at work doing his job and it would be my fault if someone got hurt by the poisons because he was not there to stop them.

John denied any history of drug or alcohol use. When I asked him about any past medical history, he told me he had just finished school and was working at his first job. He had a really hard time directly answering my questions, and he was clearly frustrated that I was not understanding what he was trying to get across.

John had blood work drawn by our phlebotomist and underwent a CT scan of his brain as he had no prior history of this behavior and I needed to make sure he didn’t have a tumor in his brain. His nurse called me a short time later to ask if there was something we could give him to help him calm down as he had escalated further, refused to stay in his room and started yelling loudly. He kept talking about poison and the bad people who were trying to hurt people. I ordered him a dose of an oral antipsychotic medication to help him calm down.

I went back to check on John about an hour later. His labs were all normal and there were no abnormalities on the CT scan of his brain. He was watching TV, lying in the bed under a blanket. When I asked him about his sleep habits, John said he hadn’t been sleeping much the past week because he had to be at the store day and night.

I told John he would be staying in the ED until he was evaluated by our psychiatrist. I talked to his mom on the phone and told her why John was brought to the ED. She said she had noticed a change in his behavior over the past several months. John lived with her through school and she was used to him not being home much as he was frequently at the library studying late into the night. She said she actually hadn’t seen him in the past week and he hadn’t been home to eat, which was unusual for him. She confirmed that John had no medical problems and had never had behavior like this before.

John continued to have delusions about poisons and seemed to be talking to people he thought were in the room when in fact he was alone. Psychiatry evaluated John in the ED and recommended psychiatric hospitalization. John was started on regular antipsychotic medications as well as medications to help regulate his sleep. He attended group therapy sessions while he was hospitalized. He rapidly showed improvement in his symptoms and became more organized in his thinking with less paranoia.

He was given a diagnosis of psychosis, which is a mental disorder characterized by a disconnection from reality. Psychosis can be a result of a psychiatric illness like schizophrenia or due to a medical condition, as a side effect of medications or drug use. Symptoms of psychosis include hallucinations, delusions, agitation and talking incoherently. The person with the condition usually is not aware of their behavior being abnormal.

John was able to be discharged home about a week later. He was to continue his medications and participate in outpatient counseling sessions. He had a follow-up appointment with his psychiatrist a few days after discharge to make sure he was stable as he integrated back into his life. His psychiatrist was hopeful that John would do well.

Dr. Erika Kube is an emergency physician who works for Mid-Ohio Emergency Services and OhioHealth.

drerikakubemd@gmail.com

This article originally appeared on The Columbus Dispatch: Dr. Kube: Emergency hold helps man get mental health treatment