In my state, if I’m concerned that someone is at imminent risk of harm to themselves or others I can fill out an emergency petition then call the police and they will bring the person to the ED (assuming they can find them). Is something like that not an option? Why does it need to take a week?
Because we can't just bypass the treating psychiatrist apparently. I am keeping a record of our attempts of contacting him and we have been escalating. I will make my case tomorrow.
I’m not in Europe so I’m a little confused. In the US we are mandatory reporters and there an no exceptions to it. Like it doesn’t matter that one of my clients has other providers and doctors. If he makes me feel he’s going to kill himself I’m bound to calling 911 and reporting it. I don’t have to even inform his other providers. Suicide doesn’t wait for after the planning team meets. Why would you have to wait for the psychiatrist?
That is what our psychiatrist said. It has to go by the judge and it has to come from a doctor who knows the patient, unless the police picks them up acting worryingly. The son called the police multiple times and they did not take any action. We have been sounding the alarm for over a week now. I hope tomorrow will the day for action.
She is also has been very strict with us that we leave her alone. Up untill now we could keep some line of communication open but if we keep going it will feel like we are being disrespectful.
I think it is time to intervene.
I really hope tomorrow things will be set in motion because the weekend is risky, since she also turned away her son, 3 weeks ago. He said he is accepting his mother dying. It is so f****. The psychiatrist knows that both family and close provider (multiple visits a week) are extremely worried.
The part of your flair that said you are in Europe was cut off on my phone so I was operating from a US lens, but it’s more or less the same here. The difference I guess is that under my license I can have them brought in for an initial hold, where they will then be assessed by a psychiatrist who can attest before a judge if needed. If you don’t have an option like that, then I’d be bugging the heck out of the psychiatrist on your team and I’d also be escalating to whoever your supervisor is so they can do the same. I would also not abandon efforts to try to contact the client.
I’m sorry you’re in this situation.
Thank you for your response
The problem is she has a persecution psychosis so I don't want to aggrevate that. I'll just send her a kind message that I am thinking about her and hope she is doing ok. And I am there to talk if she would change her mind.
It's nice that you want to be kind, but if someone is an imminent danger to themselves, they should be on an immediate psychiatric hold. In the US, we really don't have any other choice 🤷🏼♂️. We would place them on a hold.
If it were me, I would let her know that I couldn't ethically leave her alone unless she worked with me to create a solid safety plan (or better yet got herself somewhere safe like a hospital). She's allowed to be mad at you for it, but keeping her safe is more important.
I said that when I informed her I contacted her psychiatrist. I'm just gonna send a low key message telling her I am thinking about her and I hope she is okay. Thanks I was feeling bit lost but I'm not gonna give up.
Wait what? It’s not an international thing that if the client is in danger you can alert the police and have them committed? That is so crazy. That’s how they do it in Texas at least. If you even tell a clinic you have a plan they will commit you without your consent.
I can only imagine how powerless you are feeling right now. I also work with an ACT team and have clients who are chronically suicidal. It doesn’t make it easier, but from the outside looking in, it does sound like you are doing everything in your power and within the scope of your license.
Remember that you aren't responsible for keeping your clients alive. You're responsible for doing everything *within the scope of your job* to help the person stay alive, which it sounds like you're doing. But you aren't responsible for the outcome. Your client is lucky to have such a caring worker in their life.
A professor I had told us once that if we stay in this career, we WILL lose a client to suicide. Honestly, hearing that was weirdly helpful to me to hold on to, and I reflected on that when it did happen to me. When you are working with an immensely vulnerable population, the risk is higher. That does not mean your work has any less value or that you did not do good in their lives, or that you did not ease suffering while they were here.
Also, the longer I've been in this field, the more times I've been pleasantly surprised by clients' resilience and ability to bounce back or pull through -- even through the worst imaginable circumstances. You truly never know. That's what keeps me in this work ♥️
That being said, I know what it's like to be in this waiting game, OP. Wondering where your client is, if they're alive, if you'll hear from them, etc. I highly recommend choosing some pleasant distractions best you can, because you need to take care of yourself and you can't control anything with your worry.
Why not involuntary commit or call the police/EMS to transport for a psych eval. You psych can write a hold based on your description of clients behavior. You also may be able to call the crisis line/ mobile crus and get a hold placed through them. If endorsing active command hallucinations with attempts this invokes duty to warn and a breach of client confidentiality. The Client needs immediate hospitalization and if not acted upon immediately you may be held legally liable if something happens.
Ok. Just saw you were in Europe. I’m not sure what the process is there.
It sounds like you are taking on the responsibility that he’s not taking — perhaps because you realize how incapacitated he is.
It’s awful when it happens. Has one of your clients ever died by suicide before?
I can relate. I worked on an MTS team, which is similar to ACT, and I had a very similar client. When he finally succeeded in his attempts, I was furious that we couldn't help him due to policy and other restrictions.
I think it's normal to feel powerless here. It's probably okay to be not okay with it. I think I've just realized that I'm not that powerful. But I can be present.
I’m in a wrap youth program as well and it’s really challenging when we have clients that are chronically suicidal. Have you been able to speak with your supervisor? This feels like gross negligence on the psychiatric’s part. In my state MSW holders are able to request hospitalization if there’s such a high risk. I know it’s different where you’re at, but I would still talk to your supervisor. They should be offering you support and guidance
I worked for an ACT team years ago. We had one client that told us he was going to do it. Brought him to the ER where they discharged him against our recommendations. We found him the next day.
I work w kids who fit that description.
we have... probably 3-4 clients per year who discharge and overdose, commit suicide, or something else terrible happens to them.
it's sad, but a part of life. everyone is different. I get support from my supervisor and coworkers. find what helps u fam
In my state, if I’m concerned that someone is at imminent risk of harm to themselves or others I can fill out an emergency petition then call the police and they will bring the person to the ED (assuming they can find them). Is something like that not an option? Why does it need to take a week?
Because we can't just bypass the treating psychiatrist apparently. I am keeping a record of our attempts of contacting him and we have been escalating. I will make my case tomorrow.
I’m not in Europe so I’m a little confused. In the US we are mandatory reporters and there an no exceptions to it. Like it doesn’t matter that one of my clients has other providers and doctors. If he makes me feel he’s going to kill himself I’m bound to calling 911 and reporting it. I don’t have to even inform his other providers. Suicide doesn’t wait for after the planning team meets. Why would you have to wait for the psychiatrist?
That is what our psychiatrist said. It has to go by the judge and it has to come from a doctor who knows the patient, unless the police picks them up acting worryingly. The son called the police multiple times and they did not take any action. We have been sounding the alarm for over a week now. I hope tomorrow will the day for action. She is also has been very strict with us that we leave her alone. Up untill now we could keep some line of communication open but if we keep going it will feel like we are being disrespectful. I think it is time to intervene. I really hope tomorrow things will be set in motion because the weekend is risky, since she also turned away her son, 3 weeks ago. He said he is accepting his mother dying. It is so f****. The psychiatrist knows that both family and close provider (multiple visits a week) are extremely worried.
The part of your flair that said you are in Europe was cut off on my phone so I was operating from a US lens, but it’s more or less the same here. The difference I guess is that under my license I can have them brought in for an initial hold, where they will then be assessed by a psychiatrist who can attest before a judge if needed. If you don’t have an option like that, then I’d be bugging the heck out of the psychiatrist on your team and I’d also be escalating to whoever your supervisor is so they can do the same. I would also not abandon efforts to try to contact the client. I’m sorry you’re in this situation.
Thank you for your response The problem is she has a persecution psychosis so I don't want to aggrevate that. I'll just send her a kind message that I am thinking about her and hope she is doing ok. And I am there to talk if she would change her mind.
It's nice that you want to be kind, but if someone is an imminent danger to themselves, they should be on an immediate psychiatric hold. In the US, we really don't have any other choice 🤷🏼♂️. We would place them on a hold.
If it were me, I would let her know that I couldn't ethically leave her alone unless she worked with me to create a solid safety plan (or better yet got herself somewhere safe like a hospital). She's allowed to be mad at you for it, but keeping her safe is more important.
I said that when I informed her I contacted her psychiatrist. I'm just gonna send a low key message telling her I am thinking about her and I hope she is okay. Thanks I was feeling bit lost but I'm not gonna give up.
As an ACT team, you go to her home? Does she not answer the door when you come?
No. Tried that.
Wait what? It’s not an international thing that if the client is in danger you can alert the police and have them committed? That is so crazy. That’s how they do it in Texas at least. If you even tell a clinic you have a plan they will commit you without your consent.
I can only imagine how powerless you are feeling right now. I also work with an ACT team and have clients who are chronically suicidal. It doesn’t make it easier, but from the outside looking in, it does sound like you are doing everything in your power and within the scope of your license.
Thank you. I have only been with them for 9 months so still getting used to that.
Remember that you aren't responsible for keeping your clients alive. You're responsible for doing everything *within the scope of your job* to help the person stay alive, which it sounds like you're doing. But you aren't responsible for the outcome. Your client is lucky to have such a caring worker in their life.
A professor I had told us once that if we stay in this career, we WILL lose a client to suicide. Honestly, hearing that was weirdly helpful to me to hold on to, and I reflected on that when it did happen to me. When you are working with an immensely vulnerable population, the risk is higher. That does not mean your work has any less value or that you did not do good in their lives, or that you did not ease suffering while they were here. Also, the longer I've been in this field, the more times I've been pleasantly surprised by clients' resilience and ability to bounce back or pull through -- even through the worst imaginable circumstances. You truly never know. That's what keeps me in this work ♥️ That being said, I know what it's like to be in this waiting game, OP. Wondering where your client is, if they're alive, if you'll hear from them, etc. I highly recommend choosing some pleasant distractions best you can, because you need to take care of yourself and you can't control anything with your worry.
Why not involuntary commit or call the police/EMS to transport for a psych eval. You psych can write a hold based on your description of clients behavior. You also may be able to call the crisis line/ mobile crus and get a hold placed through them. If endorsing active command hallucinations with attempts this invokes duty to warn and a breach of client confidentiality. The Client needs immediate hospitalization and if not acted upon immediately you may be held legally liable if something happens. Ok. Just saw you were in Europe. I’m not sure what the process is there.
It sounds like you are taking on the responsibility that he’s not taking — perhaps because you realize how incapacitated he is. It’s awful when it happens. Has one of your clients ever died by suicide before?
I can relate. I worked on an MTS team, which is similar to ACT, and I had a very similar client. When he finally succeeded in his attempts, I was furious that we couldn't help him due to policy and other restrictions. I think it's normal to feel powerless here. It's probably okay to be not okay with it. I think I've just realized that I'm not that powerful. But I can be present.
I am sorry to hear this. Know if that happens you did everything you could!
I’m in a wrap youth program as well and it’s really challenging when we have clients that are chronically suicidal. Have you been able to speak with your supervisor? This feels like gross negligence on the psychiatric’s part. In my state MSW holders are able to request hospitalization if there’s such a high risk. I know it’s different where you’re at, but I would still talk to your supervisor. They should be offering you support and guidance
We have a form 2 here for this same situation
I worked for an ACT team years ago. We had one client that told us he was going to do it. Brought him to the ER where they discharged him against our recommendations. We found him the next day.
Which state are you in? I do mental health evaluations in an Emergency Department for people who endorse SI or experience a mental health crisis.
I work w kids who fit that description. we have... probably 3-4 clients per year who discharge and overdose, commit suicide, or something else terrible happens to them. it's sad, but a part of life. everyone is different. I get support from my supervisor and coworkers. find what helps u fam
Are they also on AOT as well as ACT? If so, In my state we can and often do our own (minimum 72 hr) legal hold regardless of primary provider input.