According to the National Alliance on Mental Illness, nearly 35,000 people in Maine suffer from severe and persistent mental illness. That number doesn’t include everyone else who lives with mental illness. Nearly 38,000 people in the state seek emergency or crisis assistance each year. Mental illness can be anything from anxiety and depression to substance abuse and schizophrenia.
In the last decade, there has been an increase in the push from state and federal agencies that govern and credential hospitals to reduce the use of chemical and physical restraints on patients. This push has been good for patients and mental health care workers alike, but the gray area comes down to when to actually use these methods to keep patients and workers safe.
The governing agencies have said that workers or a patient have to be assaulted before these methods can be used. Let me say this again, an injury has to occur before there is support enough to justify a chemical (being medication) or physical restraint.
Care for the mentally ill has come a long way over the last 50 years. Today’s care includes frequent treatment planning for specific individual needs, group therapy, individual therapy, medication, electroconvulsive therapy, recreational therapy, social skill development, educating on accessing community resources and developing skills to care for oneself.
Health care in general is seeing payment cuts. Particularly being hit are psychiatric hospitals and psychiatric patients. Patients are having their therapy session limited to a certain about of time per calendar year, as an example. For some patients, their therapist is their lifeline preventing another hospitalization.
Hospitals are attempting to cut staff and risking safety in the process. The cost of injuries to employees is enormous to both the employee and employer. The employer strains to fill the slot while the employee is out mending, which costs the employer more in the long run. Employees may find the workers’ compensation straining to their personal budget, along with emotional and physical burdens.
A few things need to be addressed in Maine. First of all, money needs to be set aside upfront for the mentally ill. By paying for the services and medication those with mental illness need to keep them out of the hospital, the state will save on the psychiatric admission (which could be multiple and for long periods of time) they won’t have to pay for.
Patients that do become abusive to other patients and mental health care workers should be charged with assault to a health care professional. The Emergency Nurses Association has been standing up for emergency care professionals’ workplace safety. Emergency departments serve the mentally ill, some in their most acute phase.
Mental health care workers should be teaming up for the same workplace safety standards. The court system and district attorneys’ office should be penalizing these patients more than they currently are. Assaulting a health care worker is a felony. Patients are coming out of court with misdemeanors, sending the message to the workers being hurt that “it’s OK.”
Employers should also be actively promoting education, training and policies to protect their employees.
Recently, I changed avenues from an emergency room nurse to a psychiatric nurse. Within two months of employment, I had been injured. The injury caused my work hours to be changed, and that change of hours meant my child had to be placed in day care. Suddenly, I have the expense of day care because I was forced to change my hours related to an injury that I didn’t ask for.
I found out that workers’ compensation is not great at all. It pays not to get injured in the first place. My situation required frequent medical professional evaluations, X-rays, the boot and even an MRI. Luckily, no surgery was necessary. One injury affected my life financially and physically.
Most of my patients are not violent. Very few in the system are violent. Working with the mentally ill, I found that they are not that different from you or me. The difference is that they have a mental illness, a biological process just like diabetes. I serve these patients just as I would in any other nursing specialty.
Even a health professional such as me can have blinders or ignorance when it comes to caring for this population. I thank all the patients I have taken care of for showing me what amazing people they are and, by that, helping me become a better health care provider.
Jennifer Kesaris of Bangor is a nurse.