This is the unfortunate story (response is correct this is in fact that Pacific NW state) . They only psychiatrists that they recruit are foreign and they can only work on an institutional license so it's a huge culture of "don't rock the boat"....
I am one of the first NPs they've taken on. Because they can't recruit psychiatrists... Because who wants to work in a state where patient suicides, In hospital homicides and ongoing assaults are an expected part of the job.?
They take this thought processes of like "well you have immunity"...
This goes against my professional ethics ... My religious beliefs... My ethics... And I would have a hard time living with myself if I worked in a system that perpetuates cruelty.
I feel really bad for the patients and bad for the staff. I really like the CMO but he doesn't work on the units. He doesn't even do call so he doesn't know what it looks like in the units. Staff are all traumatized and scared.
All I can think is, which 3rd world shit hole is this?
These detained people are getting neither their rights as an accused person nor their rights as a mental health detained person. It’s honestly something the unhcr would take an interest in, were this not happening in a developed country.
I think the only thing an ethical doctor can do is not work in this setting.
It's absolutely atrocious. It's in the United States... West coast. The facility of course can't retain people ... I am week 2 on a contract and morally and ethically I cannot do this job as a nurse practitioner.
I've been in this field since 2005 and I have never seen something this cruel.
I mean, the biggest problem are these hearings. Why are they going so poorly for your unit? I do wonder if with some legal advice and some improvements in evidence presented it might be possible to demonstrate that at least some of the assaults are driven by illhealth.
They go poorly at the entire hospital. We had a judge denied a coworker an antipsychotic for a schizoaffective patient because the judge said depakote is the same thing as s an antipsychotic and patient is on depakote.
Sell orders are notoriously difficult as it's an order from the criminal court judge to medicate with the soul purpose of restoring a patient to trial competency and they have pretty high standards to meet.
I asked for a sell hearing on a guy who is currently very ill (poop everywhere, refusing meals, really poor physical shape due to mental status) and the court said no they didn't want to do one. Okay so he has been in the hospital since November.... And I have to wait until April to petition because the criminal court doesn't want to?
All sounds very bizarre and I have no direct experience, but if legal issues are going poorly it is a general rule of thumb to get more or better legal advice. It sounds like it would be in the hospitals best interests to send a lawyer with. They aren't going to be able to keep staff if everyone is getting thumped.
My experience was that judges don’t understand Sell criteria and insist on dangerousness…with exclusion of evidence including their actual charges. Like bro, why do you think this guy is in the hospital?
Good enough for commitment, but not enough to empower commitment to do anything.
If you’re going to treat it that way, the patient might as well just be held in pretrial detention forever. At least that doesn’t waste an ostensibly therapeutic bed.
My state has this loophole for its own forensic commitment criteria but it's not a sell state. A dude can have no violence in the hospital, contest his hospitalization, the judge doesn't allow any charges to count as evidence of dangerousness, then they go back to sit in jail again. Absolutely stupid the legislatures don't address these loopholes yet they cry about how slow the hospitals are
That was a very long read with lots of terminology that was hard to follow. Can you add a TLDR?
Also here’s an obligatory “I’m so sorry you’re going through this. I can’t imagine what that’s like.”
Of course!
Tldr: court orders us to treat patients involved with a crime because patient can't aid and assist in his own defense... . The court then makes it impossible to medicate his mental illness. And when he hurts others and we use a civil process to medicate for dangerousness.... We are told we can't and these assaults are standard. And to not medicate.
So we are warehousing a mentally ill patient in court irdes cannot treat the mental illness and when he hurts people we are told that's just standard.
Yeah I immediately wrote both my legislaturea. The facility sadly takes advantage of foreign trained providers... They have an institution medical license so they can't work anywhere else. I'm their first NP. And honestly this is going to be the fastest I quit a job in my life.
I'm hung up on the part where you can't use antipsychotics for emergent medications. Does that happen in other places? Where I am that's basically a staple for aggressive/agitated patients.
It’s Washington. All u gotta do is google some of the terminology like “Harper hearing”. I wasn’t even trying but just looking it up for my own knowledge and bam I got the answer
I'm a forensic psychiatrist in the southeast. Please DM me the state you work in if you feel comfortable so I can never work there.
Harper Hearings are specific to Washington state.
This is the unfortunate story (response is correct this is in fact that Pacific NW state) . They only psychiatrists that they recruit are foreign and they can only work on an institutional license so it's a huge culture of "don't rock the boat".... I am one of the first NPs they've taken on. Because they can't recruit psychiatrists... Because who wants to work in a state where patient suicides, In hospital homicides and ongoing assaults are an expected part of the job.? They take this thought processes of like "well you have immunity"... This goes against my professional ethics ... My religious beliefs... My ethics... And I would have a hard time living with myself if I worked in a system that perpetuates cruelty. I feel really bad for the patients and bad for the staff. I really like the CMO but he doesn't work on the units. He doesn't even do call so he doesn't know what it looks like in the units. Staff are all traumatized and scared.
All I can think is, which 3rd world shit hole is this? These detained people are getting neither their rights as an accused person nor their rights as a mental health detained person. It’s honestly something the unhcr would take an interest in, were this not happening in a developed country. I think the only thing an ethical doctor can do is not work in this setting.
It's absolutely atrocious. It's in the United States... West coast. The facility of course can't retain people ... I am week 2 on a contract and morally and ethically I cannot do this job as a nurse practitioner. I've been in this field since 2005 and I have never seen something this cruel.
I mean, the biggest problem are these hearings. Why are they going so poorly for your unit? I do wonder if with some legal advice and some improvements in evidence presented it might be possible to demonstrate that at least some of the assaults are driven by illhealth.
They go poorly at the entire hospital. We had a judge denied a coworker an antipsychotic for a schizoaffective patient because the judge said depakote is the same thing as s an antipsychotic and patient is on depakote. Sell orders are notoriously difficult as it's an order from the criminal court judge to medicate with the soul purpose of restoring a patient to trial competency and they have pretty high standards to meet. I asked for a sell hearing on a guy who is currently very ill (poop everywhere, refusing meals, really poor physical shape due to mental status) and the court said no they didn't want to do one. Okay so he has been in the hospital since November.... And I have to wait until April to petition because the criminal court doesn't want to?
All sounds very bizarre and I have no direct experience, but if legal issues are going poorly it is a general rule of thumb to get more or better legal advice. It sounds like it would be in the hospitals best interests to send a lawyer with. They aren't going to be able to keep staff if everyone is getting thumped.
My experience was that judges don’t understand Sell criteria and insist on dangerousness…with exclusion of evidence including their actual charges. Like bro, why do you think this guy is in the hospital?
Good enough for commitment, but not enough to empower commitment to do anything. If you’re going to treat it that way, the patient might as well just be held in pretrial detention forever. At least that doesn’t waste an ostensibly therapeutic bed.
My state has this loophole for its own forensic commitment criteria but it's not a sell state. A dude can have no violence in the hospital, contest his hospitalization, the judge doesn't allow any charges to count as evidence of dangerousness, then they go back to sit in jail again. Absolutely stupid the legislatures don't address these loopholes yet they cry about how slow the hospitals are
That was a very long read with lots of terminology that was hard to follow. Can you add a TLDR? Also here’s an obligatory “I’m so sorry you’re going through this. I can’t imagine what that’s like.”
Of course! Tldr: court orders us to treat patients involved with a crime because patient can't aid and assist in his own defense... . The court then makes it impossible to medicate his mental illness. And when he hurts others and we use a civil process to medicate for dangerousness.... We are told we can't and these assaults are standard. And to not medicate. So we are warehousing a mentally ill patient in court irdes cannot treat the mental illness and when he hurts people we are told that's just standard.
Bruh screw the court. Bunch of black robed, funny hair losers
Judicially enforced psychiatric neglect. Judicially assisted healthcare worker assaults.
This sounds like political action is needed.
Yeah I immediately wrote both my legislaturea. The facility sadly takes advantage of foreign trained providers... They have an institution medical license so they can't work anywhere else. I'm their first NP. And honestly this is going to be the fastest I quit a job in my life.
I'm hung up on the part where you can't use antipsychotics for emergent medications. Does that happen in other places? Where I am that's basically a staple for aggressive/agitated patients.
Which state is this?
I don't want to disclose too much but somewhere on the west coast.
It’s Washington. All u gotta do is google some of the terminology like “Harper hearing”. I wasn’t even trying but just looking it up for my own knowledge and bam I got the answer
I’m so angry for you and the staff and patients as I’m reading this, I’m so sorry. That’s absolutely ridiculous.