None of us enjoy psych calls. They usually end up with a flurry of verbal and physical abuse put upon us by the patient. There are plenty of psych patients who are just going to get to that point and there will not be any coming back from it until they get that bare, dark room at the ER and sleep off their anger. I have found (I’m a psych magnet by the way, so I frequently deal with them) that you can deescalate these guys A LOT MORE than most people think. I have been able to talk down patients who were on the verge of jumping out of the back of the truck rolling down the freeway, or intent on executing homicidal tendencies. Until that first punch/spit is thrown, you have a chance to deescalate things. So let’s chat about how with some tips!
1. R-E-S-P-E-C-T! : Psych patients get respect from very few people, especially in the medical field. They have probably been bounced from facility to facility like a tumbleweed. They have been shown the worst side of healthcare, abandoned, and mistreated. Most of them have some very deep shit going on, for lack of better terms. We do not understand what is going through their head, but we do know they are human beings. I guarantee you treating them like a human being and showing them respect will earn it back 7 times out of 10.
2. Lend Me Your Ears: Something I find rookies doing is just parking their ass in the captain’s chair and ignoring their patient. This is a quick way to piss them off and relinquish control. Sitting on the bench at their side allows you to hear them out (which I highly recommend) and also puts you in a better position to see what they are doing with their hands. Sitting behind them gives up any situational awareness and by the time you realize what is happening they have unbuckled their straps and are heading out the back door, or at you. So just listen to what they have to say and keep your eyes on them.
3. Conversation: Conversation is a tricky one with these folks. This is like walking on glass, where one wrong move destroys everything you have built up so far. I try to start the conversation listening to what is bothering them, just nod and agree with everything they say. Who cares if they think the government is listening to them or took over their brain, arguing with them leaves no winners. Set your pride aside and let the people talk. I try to pick off topic pieces of the conversation out and focus on that. “So you said you dealt with the VA, what branch were you in?” “What was your job?” “Where were you stationed?” Things like that. This is where you really have to gauge your patient, because they do bring up sore spots as well. So if you start going down a path of conversation where they start getting angrier about the topic, reign it back in and reassess.
4. Safety and Control: I will admit that I let my psych patients get rowdier than most, because I have a lot of confidence in my talking abilities and if that fails I am pretty decent at physically restraining them. This all comes down to a comfort level, and I know psych calls are anything but comfortable. Make sure you stay very vigilant, pat them down even if PD did (I’ve had PD miss an 8 inch blade in a man’s waistband), watch their hands, and make sure you are always between them and the door. You also do not want them to be in control of anything. You are in charge, you are not their slave. If they are not returning the respect, they’ve lost yours.
This was kind of a spitballed post, so hopefully someone got something good out of it. Feel free to reblog this with your tips on dealing with psych patients. I am a firm advocate for increasing our knowledge and training with psych patients, because none of us are as well trained as we could be to handle them properly.
