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In 2011 serious mental illness is a psychiatric diagnoses lasting 6 mos. or longer. A variety of services are available but many are hampered by poor and obsolete clinical treatment models. In this page we examine how a nurse, a doctor, a patient all with the best intentions can loose their way by abandoning publicly acceptable standards of practice. Each with competing priorities. Should there be a psychiatrist on staff ?
Real Life Practice Conflicts
Real Life Psychiatric Practice Standards
A case study about applying standards
Family members prevent therapy progress for various reasons that are intentional, possibly punishing, or unintended to be believed or thought helpful. Both types can be are harmful or helpful. Outside the family support network guardians, lawyers,etc. contribute their brand of harm. At the same time, each can be quite helpful and hopeful participants in the lives of the mentally ill depending what the patient needs. Its quite human to have destructive and helpful relationships in our lives so my point is you cannot escape personality types like this. The role of the psychotherapist is to edit the sequence of events each person acts trying to benefit the patient and still remain responsible to society; in this case where Medicare is involved part of that is to prevent mental illness hospital stays and accidents.
Turning our attention to reality follows is an example that involves an actual situation where a staff member attempts to help a patient without the last hospital record or outpatient reports. Our example begins with one staff writing in the record “patient has anxiety”. This took place in a facility.
But did he have clinical anxiety? He did not meet any clinical criteria under anxiety disorder in the DSM nor was there a history of it.Which would not have been bad as a written progress note or observation, until the staff member called the internal medicine MD who prescribed meds immediately. That staff had limited qualifications as a licensed practical nurse 2 yrs college. Did the MD perform responsibly ? Could he have asked for a psychiatric consultation ?
Why wasn’t a psychiatric exam given? None are on staff. Now we see why relatives, friends, attorney, guardian, become involved because there are times when the clinical process should be stopped and examined closely because facilities cannot police themselves.
Third, in this example I want to point out the proper response from someone interested in the patient in this situation is to ask the facility to provide a psychiatrist or neurologist or just make the appointment with one and transport the patient there before issuing psychiatric medications. When the facility does this themselves then they are responsible members of society because they abide by the proper professional clinical process. When they do not they are irresponsible. A series of punishments are given for this kind of behavior but it still is not rare.
Update on this: The patient began to feel agitated and became out of control. Agitation is a well known side effect of some anti anxiety medications. The patient also lost the ability to speak rationally.He was observed flipping thru same book pages for four hours looking confused.Only to begin again and again.
Assessment for mental illness is the purview of those licensed mental health professionals for whom such a skip over standard practice would not be acceptable. A therapeutic process may need to be stopped. For reference, one has to examine what the DEA says about such cases as the one we presented here. Dr. Ilem obviously not the only MD issuing medications without proper processes?
Medical Doctor Psychiatrist
Why Are Standard Processes Ignored?
Non Psychiatry Profits?
DEA says an exam should be given before prescribing. Are they right?
Just Follow Mental Illness Case Standards For Yourself
