tag:blogger.com,1999:blog-7772182113499451603.post7652256632960412969..comments2024-03-18T14:35:03.634-05:00Comments on Real Psychiatry: Minnesota State Hospitals Need To Be Managed To Minimize AggressionGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-7772182113499451603.post-30764933115363118972016-01-13T20:29:34.386-06:002016-01-13T20:29:34.386-06:00Thank you so much for the reply. Looking forward t...Thank you so much for the reply. Looking forward to reading more about your take on AMRTC.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-82388138093700657802016-01-09T11:29:21.867-06:002016-01-09T11:29:21.867-06:00Thanks for your question. I have a previous post ...Thanks for your question. I have a previous post on another incident in a Minnesota hospital:<br /><br />http://real-psychiatry.blogspot.com/2014/12/more-on-violence-and-aggression-in.html<br /><br />I can't speak to this case in particular but I can add a few general concepts based on my experience working a county hospitals around a lot of aggressive individuals. Firearms in hospitals are generally not a good idea. They are not a deterrent to people who are aggressive and have severe impairments in judgment or see them as a means to escape or perpetrate violence. The law enforcement officers involved are also not able to maintain a high enough level of vigilance to prevent an unexpected attack. A hospital environment is not generally a very stimulating environment. There may be a significant amount of background noise, but there are not a lot of events that require focused attention - like very low frequency aggressive events.<br /><br />That means that the best protection against these events are physical barriers to protect people from the aggressive person. In the hospitals where I have worked those barriers include jail cell units where incarcerated patients who need acute medical treatment can be transferred to and entire 18-20 bed units that specialize in treating aggressive men. There is a need for similar spaces for aggressive women but that tends to be a rarer problem. The units themselves have to be staffed with people who are comfortable dealing with aggression and who know how to address it. The environment has to be secured against contraband weapons and drugs and all material coming into the unit needs to be searched. Metal detectors are also employed to detect any weapons coming into the unit.<br /><br />The person making the assessment of the potentially violent or aggressive person needs to have experience making these determinations and have a level of comfort with the dispositions - specifically where the person could be safely treated. They also have to be very aware of any threats to their safety along the way. One of my themes on this blog is that there are not many places where this can happen. In the state of Minnesota for example, although there are many community hospitals - only a few have psychiatric units. Of those 20 or so psychiatric units - there are less than a handful that have the capacity to treat highly aggressive patients. These resources need to be better developed and the psychiatrists who specialize in this area need to be given more resources and freedom to address this need. There are too many unnecessary injuries and deaths and too many lives wasted because at the root of the aggression - there was a treatable problem.<br /><br />On the issue of telepsychiatry, it has been around for a long time. As early as 1988, I was approached by a satellite TV company who was interested in developing this service for Northern Minnesota. One of my colleagues did it for a number of years for an outpatient clinic in a remote area, but they had a rule that she had to see the patient in person every 4 visits. I think a lot of it has to do with the quality of the assessment and I am certain that there will be some video assessments that are superior to some face-to-face evaluations. Lately I think that there is a cultural component that has been missed and that is patient acceptability. It is one thing to have a study, that asks that question in a sample of people who may be interested in the technology. I have found that in clinical practice there are significant numbers of patients who do not consider it to be acceptable at all and consider it to be the equivalent of no evaluation. That might be an issue that can be determined in advance but it needs further study. George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-19818554408234244342016-01-09T10:09:17.158-06:002016-01-09T10:09:17.158-06:00I was wondering if you can comment about the St. C...I was wondering if you can comment about the St. Cloud MN hospital shooting where a psychiatric patient was not evaluated by a psychiatrist and was released with the general patient population who in turn overpowered and shot the deputy guarding him with his own gun. He could have shot other patients and staff but luckily, he was subdued in time to cause more damage. The hospital erred by not having a proper evaluation of the patient but I believe he was evaluated by a PA instead. What do you think of this common practice to save money and also the use of tele-health psychiatrists to provide consultations in the ER or other setting.<br />Thank you in advance. I enjoy reading your blog. <br /><br />Anonymousnoreply@blogger.com