Tuesday 4 February 2014

Please tell me this is not happening...

Ok, I haven't worked in the public mental health system since 2009. OK I might be misinformed. But I am hearing more and more from colleagues that a reduction in staffing in public hospitals is leading to increased use of major antipsychotic medications to sedate patients, so they require less intensive support and care. Known as 'chemical restraint', this method is being used over safer methods during the acute period a patient may be agitated and require transportation. Now, anybody who has not witnessed first hand how unwell and distressed patients with acute mental illness can be may find this diffiicult to comprehend. But doctors and nurses are duty bound to ensure they keep patients safe from themselves and others until better. The safest way is to use trained staff to calm patients, proivde one on one support and supervision, in a low stimulus environment. The same goes for patients who are agitated and distressed from head trauma or brain infection as well. Hospitals should be able to rely on teams of trained staff to use their expert skills to contain patients, thus minimising the need to use antipsychotic medications to achieve this.
However, the word on the street is because of staff shortages and more acuity in patients, the use of chemical restraint is becoming more routine in situations where patients need to be transported or contained. Chemical restraint is achieved by injecting medications used for illnesses such as schizophrenia.
So, what happens to patients when they are given cumulative doses of major antipsychotic medications? Well, they may experience respiratory depression, ie unable to breathe effectively, and may end up with pneumonia. They may experience severe side effects of potent medications, particulalrly if already on regular doses of medications. And when chemically sedated, they can't alert anybody that they may be experiencing symptoms of this.
In no way am I blaming the staff who do a superb job working with patients who are very unwell. I am blaming a public health system that looks at dollars, cuts brutally and without consideration, and I feel for the vulnerable patients with acute mental illness that suffer as a result.

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