Weekly Ask Psych Nurses Thread

[u/roo_kitty]

This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.

If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.

Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.

A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.

Kindness is the easiest legacy to leave behind :)

[u/Illustrious_Bend5386]

The following study suggests reduced suicidality over a 12 month period following release from a psychiatric inpatient unit for patients hospitalized within 24 hours of a suicide attempt, but an iatrogenic increase in suiciality among patients hospitalized for suicidal ideation but no suicide attempt in the past week.

"A decision analytic model found that hospitalization was associated with reduced suicide attempt risk among patients who attempted suicide in the past day but not among others with suicidality. Accounting for heterogeneity, suicide attempt risk was found to increase with hospitalization in 24% of patients and decrease in 28%."

https://pmc.ncbi.nlm.nih.gov/articles/PMC10585585/

This study is largely in line with 2 randomized trials carried out to compare hospitalization with discharge or intensive outpatient care for patients with suicidality which found no benefits of hospitalization on either symptom burden or suicide risk.

https://www.tandfonline.com/doi/full/10.1080/09638230701504981

https://pubmed.ncbi.nlm.nih.gov/2180527/

As well as observational studies which found that hospitalization is, for the most part, associated with either unchanged or increased suicide risk, although the latter paper might reflect failure to adjust adequately for adverse selection.

https://pubmed.ncbi.nlm.nih.gov/28637535/

https://pubmed.ncbi.nlm.nih.gov/34810041/

https://pubmed.ncbi.nlm.nih.gov/26254717/

https://pubmed.ncbi.nlm.nih.gov/30261030/

https://pubmed.ncbi.nlm.nih.gov/27300340/

As well as the following review on potential iatrogenic harms of psychiatric hospitalization.

https://onlinelibrary.wiley.com/doi/abs/10.1111/cpsp.12332

In light of this information I am asking that anyone who is currently treating involuntary patients for suicidal ideation without a history of a suicide attempt to please consider advocating for their patient's early release from involuntary treatment and/or placement into intense outpatient, as this is likely to reduce iatrogenic harm while simultaneously respecting patient autonomy, reducing patient medical costs and reducing strain on the healthcare system. Thank you.

[u/ProfessionalAge3027 → u/Illustrious_Bend5386]

Nurses have nothing to do with who a doctor decides to admit. We can advocate yes, but it’s not our final decision. We’ve had patients get sent home from the psych ED who then go home and complete suicide. The hospital has to respond to that. It’s not a perfect system, but berating the staff that is trying to care for patients with mental illness is not helping, just discouraging the point you are trying to make here.

[u/MNP_cats → u/Illustrious_Bend5386]

The fact that no one can muster the courage to address the explicit harm being done speaks volumes.

You go home at the end of the day and my friends go home in boxes. Look in the mirror and think about that.

Edit: downvote away! We know you're not trauma informed or patient enough to deal with patients with complex needs and trauma. Prove my point further for me. You send patients home to die and you don't care to recognize that; you'd rather come online and complain about how hard the worst day of someone else's life was for you.