Mental Health Evaluation

Probably the majority of patients that I watch in the west hall (or in any other room I guess) are those that are in need of a Mental Health Enquiry/Evaluation or MHE. This covers a very large spectrum of reasons, but for the most part it's an altered state of mind from the norm. This could be from suicidal thoughts, extreme confusion, dillusions, hallucinations, etc. These patients probably make up about 90%of the ones that we watch because a MHE can be in combination with anything else.

Depression is one of the largest factors as to why people have suicidal thoughts / attempts and it's usually over something, in my opinion, trivial. Relationships are a big one. When someone breaks up with another, depending on how their mental make up is in the first place, also in my opinion, will be taken to such an extreme they will feel that their life is no longer of worth and will want to take it. There are some stories people have told me that are very tradgic as to why they are where they are now such as abuse from a significant other. It's very disturbing that someone who supposedly loves you will take advantage of you mentally, physically, financially. It's not love though. But it happens unfortunately and people will do what they think would "end the pain". Most commonly in the form of an Overdose on an illegal or legal substance or through self-mutilation.

When a patient is brought in for an overdose, depending on the amount of substance ingested and how long ago will determine the treatment for the overdose. Most commonly the patient will have to down, according to Wikipedia "1 gram/kg of body weight ( for adolescents or adults, give 50–100 g )" of Activated Charcoal. I haven't asked a nurse exactly how much is in a standard bottle of Activated Charcoal but it's a lot. The purpose of it is to absorb all the chemicals from the ingested substance rather than something like Ipecac which makes you vomit. Eventually the Activated Charcoal will leave your body in the form of explosive diarreah and vomit but not until after some time. Then after the patient is medically stable a social worker will be assigned to talk to the patient about what had happened that led up to the situation that they are in now. From there the social worker will determine if they are okay to go home after they are medically cleared and will give them some information on how to seek help from therapists or go through some kind of out patient program. Or if the social worker believes that the patient may need to seek something more serious, they will call a County Designated Mental Health Professional also known as CDHMP or we usually just say DMHP.

Unfortunately there's only like 1 or 2 that work shifts, or so it seems, so the wait a patient may endure before seeing a DMHP can be anywhere from 1-4+ hours. Once the DMHP comes and makes a mental evaluation of the patient, similar to Social work, they will either let them go home and give them information on therapists or other outpatient-like help or they have the power by law to legally detain someone against their will to be placed in a Mental Institution. Sometimes at a low-security facility for like 3-7 days or even longer at a locked-down facility. This can be tricky because the DMPH can detain someone for up to 72 hours excluding holidays and weekends. This means that if you are detained on Friday at 0000. You can be there all day friday, saturday, sunday and technically only have been detained for 24 hours. Usually doesn't happen, but it happens.

One time that this had happened, had happend to a patient that had Alzheimer's disase. Some background as to why he was brought to the hospital. His daughter had called the police on him because he was getting violent with her and swung his cane at his wife. He had no recolection of ever swinging at his wife and that he would never do such a thing. The thought of such had made him start to cry. He had believed that he was in California when we asked him where he was. The information that he gave us as to where he lived was correct, but he had come to Washington the day before and did not remember ever leaving California. This guy was a pretty nice old guy for the most part. Unfortuantely he kept asking us why he was here at the hospital every 8 minutes or so. And when we would tell him that we had just told him why he was here and would get upset at us and call us liars for never have telling him why he was here. We would tell him the same story every time, and everytime he would yell at us for being liars. He began to become aggressive towards the staff and other guards so we had to move him from the regular hospital room of the west hall to one of the plain white rooms, just so he had less objects to throw at us.

So far he had been in the room for about 4 hours, we gave him a recliner chair similar to the ones that are in the Birthing Unit. They're pretty comfy. But according to him he had been in that room for about 3 days without food or water and not able to make any contact with anyone in the outside world. This was not true because we'll ask a patient if they need any food, water, restroom, warm enough, every 15-20 minutes or so depending on how they may actually be. The DMHP had eventually came and had detained him. Unfortuantely for him it was on a Friday and the daughter and wife were not returning any of the calls. So this guy was going to be stuck with us for awhile. He ended up staying with us for about 3-4 days overall. But his story ended up being about two weeks. I felt bad for him. But there's virtually nothing that can be done about his mental state. It's a very sad disease.

And on a scary note, he had a Valid Driver's license.

Some other patients I've dealt with with mental disorders are commonly diagnosed with scizophrenia / paranoia and the patient is going through a psychotic episode or they have stopped taking their medications. A common perscribed drug I've seen is Quetiapine, commonly known as Seroquel. Some serious side effects happens when people either take too much of the medication, take the medication with alcohol, or stop taking it all together as listed by drugs.com: mood or behavior changes, anxiety, panic attacks, trouble sleeping, feeling impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or self-mutilation.


Pretty serious stuff. A patient I was watching after had taken too much seroquel with a mixture of alcohol had knocked his thoughts all out of whack. He was put in to 4 point restraints for his own safefy because he didn't know who he was, where he was, how old he was, what year it was, etc. He would pass out for a few minutes, then wake up talking about a Construction site he's working at and needs to tear down a wall. Then would pass out again. Then would wake up again asking to see his mom, and that she was just down the hall in the living room watching tv. Then he would pass out again. And then he would wake up and I would ask him if he knew what was going on and he would look at me and say "Yeah, I know what's going on. I understand everything you're saying. There are no problems here at all." and then would pass out again and continue to talk in his sleep. I don't think he was suicidal, but just took too much medication and mixed it with alcohol.

Another patient who also took the medication was brought in to the ER for Suicidal Ideations and self-mutilation on his forearm. His ex-girlfriend had broken up with him a year ago or so on unruly terms. And she had called him that evening saying that she would call him every year on his birthday and call him names and such until he would finally just kill himself. Well he said he took a bunch of his medication and doesn't remember carving "HELP ME" in his forearm. He was in the ER with his roommate and he swore that he did not do it, but someone else inside his head had done so. Talking to him he seemed alright. But he wasn't alright. They ended up making 9 or 10 stitches in his arm on the deep insesions and used the medical super glue on the rest of his cuts and wrapped it up.

Again, another victim of abuse. Words are very powerful and people don't understand that sometimes. Or maybe they do. Either way, they are terrible human beings to where they dilberatly want to harm someone else and should be jailed.

I'll probably write more stories about Mental Health patients later. Some are kinda funny, most are sad. But eh, that's life. My next post will probably be about Combative Patients I've dealt with.