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Thursday, May 20, 2010

Work in Progress

As you know I work in psychiatry. When I'm out in the public I am reminded all the more that society is far, very far from understanding this population. The primary reaction I get from people is fear, and soemtimes disbelief that I love working with these people. I do not fear those with mental illness as the average joe who does not know anything about psychosis, or depression or bi-polar would. Who can blame him though? The media portrayal of those with mental illness is skewed. No wonder they are misunderstood. (uh oh, I might be opening a can of worms here...) Media tend to show only the the dangerous, the scary side. I am not saying that there is absolutely no violence related to this aggreate. 2009 had a number of incidents in the news. All I'm saying is that most of the mentally ill are not as dangerous as the movies or tv portray. As a group, mentally ill people are no more violent than any other group. According to the Canadian Mental Health Association, they are, in fact, more likely to be the victims of violence than to be violent themselves.

Only those in the same field, or those that have more experience with them will understand this. There is a show called "Stand up for Mental Health" created by David Granirer, a counsellor. He taught stand up comedy to those who have mental illness as a way for them to fight the stigma, to educate the public, and to counter discrimination. It's worth a look. Here's the website I didn't get to see it when they came to my little town but maybe next time :)

In line with this, I wanna talk about self-awareness... one of the most important skills to master when you are a nurse. The things that our patients have done before entering the hospital can sometimes be in conflict with our own values and beliefs. One needs to be able to withhold judgement, and keep oneself in check. This doesn't just apply to psychiatry.It goes the same for addictions, forensics etc.

For me, one of the hardest issues is suicide. When my patient is suicidal, I feel I need to exert more effort in taking a few moments before starting my interaction with the patient. Personally, it is very hard to be assigned to someone who wants to end their life. My personal values conflict with this. Especially as a brand new nurse, I'm still honing my therapeutic skills, and trying not to view actual cases as clear-cut textbook cases- as those are the ones I am used to. "Given situation A, steps 1, 2, and 3 have to be performed". That's not exactly how it goes in psychiatry. It is a science and an art at the same time. And I have a long way to go in learning to apply both the science and the art aspects. It's still a work in progress... Everyday, I bank on some experience and supplement the textbook knowledge that I have.

Nonetheless, I find that this helps me when assessing suicidality of a patient. Textbook, I know, but it's an important tool to incorporate in the interaction. It's from Shea's Psychiatric Interviewing.

Lethal triad:
o Presenting hx of a serious suicide attempt
o Presence of acutely disturbing psychotic processes suggestive of lethality
o Indication from the interview that the patient seriously intends to harm self (single most important indication of suicide potential)

The presence of any one of these should warn the clinician that suicide may be imminent risk

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