Psychiatric Emergency Services

We take one night of call with Psychiatric Emergency Services from 6pm-11pm. Psychiatric emergencies often involve 5150's (involuntary holds) for suicidal attempts, homicidal ideations, or grave disability (such as inability to provide food or severe alcoholism). Patients may self-present to the emergency room, but most are brought in by police, security, or case managers. The range of patients is stunning; there are those who are constantly shouting, those with active psychosis, those who honestly are just looking for a place to stay for the night. The emergency department has interview rooms where security can watch, panic buttons in case staff is threatened, and seclusion rooms (not padded, but close).

I interviewed a patient who was having suicidal thoughts, but the story became extraordinarily complicated with diagnosis of breast cancer subsequently leading to a broken relationship (the boyfriend left because the patient had a lumpectomy) and loss of housing. We also saw a patient with borderline personality disorder, a diagnosis of an incredibly volatile mood. He wanted to kill his father and then he threatened us when we refused to let him do so. It got to a point where he wouldn't even communicate with us, telling us that he would only talk and listen to the "nice nurse." It was a crazy evening.