What to do with a patient in crisis?

Let's suppose that we have a psychotic patient. I am not a big fan of psychiatry but what to do at that moment? What kind of alternatives do we have? If the client is not in contact with reality (as we know it) he/she can injure himself/herself or someone else.

What to do instead of calling a psychiatrist in such a case?

Psychosis is the natural state of human existence. If someone is ushered into the mental health system, they will go brain dead. Please keep that in mind if you have a heart at all. There are other ways to contact reality, ***mod edit*** Injuring someone is not a reason to kill someone's brain off completely. Basically just offer someone *mod edit* and they would calm down. Never under any circumstance call someone into a mental hospital for any reason whatsoever. Even an outside appointment can damage their brain potentially.

There are two assumptions you make about psychotic patients. One is that psychosis necessary leads to someone being a danger to themselves and others. That is not true. All psychosis means is that someone is experiencing a different reality than other people around them. Another is that being "mentally ill" (or whatever other term you may use for someone who experiences reality differently than most people do or experiences more extreme emotions than most people do) causes someone to be a danger to others. "Mentally ill" people are actually more likely to be a danger to themselves than others, and they are more likely to be victims of violence than be violent towards others.

If someone truly is a danger to themselves due to "mental illness", they should not be subjected to force, unlike what is the status quo for mental health care. That makes the situation worse, as that exposes them to stress and could potentially traumatize them. One exception would be if someone is in immediate danger, like if that person is about to jump out a window. The restraint should not be chemical, as drugs linger in the system for a much longer time than the situation that the drugs were administered for, and its effects on the brain may be permanent. And even then, after a person is restrained, the person should be calmed down after being removed from the situation. Crises like that happen when someone is under serious distress.

If the person is not in immediate danger, the person should be given emotional support. It goes to the root of their distress rather than focus on the person's behavior at the expense of its cause.

Don't take them to a smoke free hospital. Anyone who has ever seen a person get upset psychiatric inpatient when they are told they can't smoke knows how that often goes down, the goon squad, the assault, the needle and the restraints.

I guess they started banning smoking psychiatric inpatient to increase profits, the more agitated people are and the more they act out the more crap they can write on the charts and hold them longer.

But you ca have a nicotine patch... Give me a ######6 break, everyone knows you need that direct hit from smoking and that little trickle from the patch doesnt do $#%^ and thats why most people fail to stop smoking when they try those.

Hi we are psychiatry, we know that even when mentally sound people quit smoking they get all kinds of agitated and upset, so that is what we are going to do to you right now in the middle of your crisis.

JosephPSY wrote:What to do instead of calling a psychiatrist in such a case?

1. Eliminate all potential sources of harm to self and others from the environment.
2. If the patient is physically violent, physically restrain as necessary - restrain enough to eliminate all risk of harm but otherwise as little as possible. No need to strap them to a bed if you can just lock a door. If the patient does get physically restrained, make sure to communicate to them that it is temporary and in their interest.
3. Establish communication to help the patient be as much in touch with reality as possible.
4. Look after all of their immediate needs as soon as possible, from the ground up: air, water, food, physical comfort, social interaction, objects or activities they might like (crayons, puzzles, music, etc.). It is best to avoid having them watch TV or listen to the radio, and even for music, it is best not to allow headphones (look up ideas of reference).
5. Communicate to the patient that they are safe and that you are on their side.
6. Try to locate someone who knows the patient and whose presence might help the patient to calm down and reconnect with reality.
7. Offer them to talk to someone, and if they are not interested, make sure someone to talk to is available if they change their minds. As long as the patient is psychotic, topics should be limited and the reason why they are in hospital, the fact that they have a psychosis and the events of the day should be avoided as much as possible. If the patient raises those topics, don't refuse to discuss them, just subtly steer the conversation in another direction.
8. Never leave them alone, but don't be intrusive either.
9. Do not under any circumstance deny the delusions or hallucinations of the patient so long as they are psychotic. This could antagonize the patient. If for example they believe their nurse is the devil, don't deny it - get her out of the room and find a different nurse. If they complain of ghosts or extraterrestrials being present, acknowledge it and tell them that you are on it. Tell them how they can help you with this: taking that mild sedative, having a chat with you, etc.
10. All discussions in the presence of the patient should be easy for them to hear and they should be able to see faces. Don't whisper in their presence, don't turn your backs on them. If someone needs to say something that might be misunderstood or misinterpreted by the patient or if it is best that the patient doesn't hear what is being said, say those things out of sight of the patient.

Chemical restriction in my opinion is the lazy technique. I bet the only reason it exists is because of its cost-effectiveness. If you could chemically restrain all of your patients, you could let go a bunch of nurses, orderlies and guards. It should be banned. Not to mention that forcing someone to take pills or to get injections in and of its own is traumatic enough that it might actually make things worse. On the other hand, offering a mild sedative and explaining that it will help the patient feel safe is a great idea, always stressing the fact that it is entirely their decision and that nobody will force it upon them.

I agree with Copy_Cat, a psychotic crisis is not the right time or context to get someone to quit smoking. I am no expert, but allowing a psychotic patient to smoke might actually help them reconnect with reality. A person who is psychotic could hurt themselves or others with a lit cigarette, so it is a little tricky, but if at all possible, let them have their smoke. At least have a vape pipe handy, with a liquid that tastes like the real thing.

But yes, the patient will need to speak to a psychiatrist soon enough. I am not a fan of psychiatry either, but unfortunately, the system is the system. Also, if the patient might harm self or others, the psychiatrist cannot magically fix that. The only thing they can do that you can't is chemically restrain the patient.