I received so much feedback on my last post entitled “Open Letter to All Hospital Emergency Ward Staff” that it only seems fitting to continue the conversation.

 In the letter I wrote about what I think all health professionals need to know about someone who is in an acute psychotic episode.

The letter echoes a remark I made in 2011 to health reporter, Andre Picard. In his article about the practice of restraining patients who are in acute psychosis, I explained “I may be crazy but I’m not deaf. Good caregivers can be forceful and still respectful.” This is at the crux of my open letter: compassion is as healing as the medications we take and the services we receive. More so at times.

Michael Groberman from Vancouver responded to my open letter: "Your plea touches me. I have been in a similar position and heard nurses speaking of me in the third person. I have had my depression crisis dismissed as attention seeking by resentful and overworked nurses. I have also experienced the kindness you describe so eloquently."

 Michael’s poignant Globe & Mail piece “My day as a ‘mental patient’” vividly affirms how small acts of kindness have a big impact and the lack of them are dehumanizing.

Ontario psychotherapist Lina Farias’s comments highlighted something equally essential. The lack of support ERs have preventing them from successfully helping individuals in psychiatric emergencies. Here is her letter in full:

 “The problem is much bigger than the overworked, overstressed ER staff who sometimes loose his/her compassion. The ERs are under constant pressure of filling the gaps in the medical system. On other hand ERs were designed to deal with severe physical injuries and ones of mental crises often fall to the end of the line. Having said, that this does not excuse anyone in the ER from showing lack of kindness to you.

Physical layouts of most ER departments (that I have seen) are not appropriately designed for mental health crisis patients, as they are lacking in privacy, security and in many cases lacking ER staff trained to deal with psychiatric emergencies.

Few hospitals are designated for psychiatric emergencies. From what I have seen, in my area, the best you could get is a Social Worker or a Nurse and only after hours of waiting you will get a brief assessment by a psychiatric resident.

As we are advocating for better mental health services let's start with ERs by asking what do they need to support psychiatric emergencies and mental health beds for emergencies. Let’s start talking about physical layouts, triage, staffing,...etc. Have you ever heard about Psychologist working in the ER? What about counselling while patient is recovering from an overdose?

By removing excessive pressure and bringing more competent resources to the ER you will get more compassion and better service. Thank you again for reminding us that we are all humans and we all have feelings and that it costs nothing to be more compassionate.”

Hear! Hear Michael and Lina. And to all of you who chimed in and had your say about my requests for compassionate care even in the midst of florid psychotic behaviour.

It begs the question with such a high number of individuals who experience psychosis (3 out of every 100 people), why aren’t ERs set up to deal with psychiatric emergencies more effectively? Why don’t we have more staff expressly trained in psychiatric emergencies posted in every ER? And since we don’t what can we do to change this? Your ideas and suggestions are welcome.

© Victoria Maxwell 2014                                        www.victoriamaxwell.com

Image courtesy of taoty / FreeDigitalPhotos.net

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