According to Sadock et al., (2014), a psychiatric emergency is any troubling thoughts, emotions, or actions for which prompt therapeutic intervention is required. Regardless of whether the individual experiencing a psychiatric emergency is a minor or an adult, clinicians must ensure the safety of each client at all times and be familiar with the signs and symptoms of a psychiatric emergency. Examples of a psychiatric emergency include abuse of a substance, violence in the form of suicide, homicide, and rape; acute psychosis, as well as social problems such as homelessness, competence, and acquired immune deficiency syndrome (AIDS) (Sadock et al., 2014).
One of the psychiatric emergency cases I can recall involved a 23-year-old male of Asian descent with no prior hospitalization. This client had attempted suicide by hanging 3 days before he was being brought to the psychiatric hospital. This individual was found unresponsive by his girlfriend who they have been together and lived in the same apartment for three years. Per the girlfriend, she cut off the piece of rope from the client’s neck and called “911.” While waiting for the paramedics to arrive, the girlfriend began administering CPR. Luckily enough the paramedics arrived when the client was drifting in-and-out of consciousness so he was resuscitated and put on oxygen before taken to an emergency room for clearance before transported under an “emergency warrant” to the psychiatric facility where I work. While in the psychiatric hospital, client reports during a comprehensive nursing assessment that his reason for attempting to commit suicide was because his girlfriend told him she is breaking up with him after he caught her in bed with another man. Pt appeared anxious and depressed, and when he was asked about suicidal ideation, he just shrugs his shoulders and said, “I just can’t see myself living with this mess.” The client was then evaluated by a psychiatrist and he was placed on a “one-to-one” observation with suicidal precaution, where there is one staff assigned to monitor the client at arm’s length 24 hours a day. Group psychotherapy and daily antidepressant were also ordered. This client positively recovered and was discharged home after spending a week in the psychiatric acute care unit.
Treatment for Child vs. Adult:
Psychiatric emergencies in children and adolescents are not uncommon. The initial psychiatric evaluation for children would be the same as that for adults but in more simplified words and phrases. A child may be question intensely about stressors at school, such as bullying or his/her activities on social media. The child’s interests and hobbies, as well as the child’s family dynamics, would also be assessed. According to the American Academy of Child & Adolescent Psychiatry (2018), a child should be immediately taken for an emergency evaluation if they present symptoms such as the risk of harm to self or others (e.g. saying in person or online that they want to kill themselves, searching online about how to kill themselves, taking steps to kill themselves like stockpiling pills, making a noose, or getting a gun or other weapons, writing a suicide note, giving away favorite belongings or making a will, cutting or hurting themselves in order to die or not talking about why, saying in person or online that they plan to kill a person or large groups of people, becoming more violent towards others, starting fires, destroying property, or harming animals, threatening a person with a weapon), or changes in behavior or thinking (e.g. acting strangely or not making sense, losing touch with reality, seeing or hearing things that are not there, becoming paranoid). Unlike with adults, family therapy is also included in the treatment of children, and informed consent is needed from the child’s parents or guardian before starting any medication for children. Furthermore, adults are more likely to seek help for themselves during a psychiatric emergency, but most children would not seek help when in crisis; it is usually the child’s parents, teachers, or child protective services that help with the initiation of treatment (Sadock et al., 2014).
Legal and Ethical Issues:
Several ethical and legal issues are involved when caring for a child or adolescent. One of the most common ethical issues is that of consent for medication. During the child’s course of treatment, consent must be obtained from the parents or guardians whenever a medication is increased, decreased, or changed. Clinicians must also involve the child in his or her treatment, and properly educate both the child and parents or guardians about the proposed medication (Chun, 2013). Confidentiality is another major issue of concern when dealing with children or adults. Clinicians are faced with greater challenges in their effort to protect the privacy of their parents. Although parents and guardians have the right to be informed about the form of treatment given to their child, including psychotherapy and treatment progress, in a situation where the parents of a child are going through a divorce, the disclosure of the child’s privacy information is not to be shared with the party who does not have custody of the child. This could cause an ethical dilemma if there is no paperwork to show (Bipeta, 2019).
American Academy of Child & Adolescent Psychiatry, (2018). What is a psychiatric
Bipeta, R.(2019). Legal and ethical aspects of mental health care. National Center for
Chun, T., Katz, R., & Duffy, J. (2013). Pediatric mental health emergencies and special health
care needs. National Center for Biotechnology Information.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry:
Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.