Tim Webb – Emergency Mental Health: Assessment and Treatment

Outline

SUICIDE RISK ASSESSMENT AND INTERVENTION

• Identify those patients most at risk
• Unique differences in adolescent and geriatric suicides
• Two questions the patient must answer
• The two types of suicidal patients
• Interview strategies and techniques
• Which instruments to use for assessment
• Develop clinically sound safety plans
• When and how to manage the patient as an outpatient
• When to hospitalize the patient
• When and how to involuntarily commit the patient
• The role of managed care and third party payers

HOMICIDE AND VIOLENCE RISK ASSSESSMENT AND INTERVENTION

• Keeping yourself and others safe with the violent patient
• Identify those patients most at risk
• Differences in interviewing the violent and suicidal patient
• Interview strategies and techniques for the violent patient
• The two types of violence
• Which instruments to use for assessment
• Unique risk factors for school violence
• Assessing the risk for workplace violence
• When to hospitalize the patient
• When and how to involuntarily commit the patient
• The role of managed care and third party payers

MENTAL STATUS EXAMINATIONS

• Elements of a mental status examination
• Understand and identify psychotic symptoms
• The role of medical conditions and substance use in the examination and disposition
• Backtracking a diagnosis based on the patient’s medication list
• Which medications are used for specific disorders
• The role of “medical clearance,” laboratory studies, and medical conditions affecting disposition
• Managing malingerers

HOW TO ASSESS THE CHEMICALLY DEPENDENT PATIENT

• Which substances require detoxification
• Medical vs. traditional vs. social vs. outpatient detox
• Using the CAGE to assess for alcoholism
• Using the CIWA to assess alcohol withdrawal
• Medications and vitamins vital to safe detoxification
• Assessing the withdrawing patient
• Making a level of care recommendation for the substance-abusing patient
• Integrate laboratory studies and medical histories into the assessment
• The role of managed care and third party payers

APPRECIATE THE ETHICAL, LEGAL AND LIABILITY

IMPLICATIONS OF MENTAL HEALTH EMERGENCIES

• Ethical responsibilities
• Appreciate the results of the Tarasoff court case, especially the duty to warn and protect
• Understand when and how EMTALA applies
• Learn whether to “contract for safety”
• Understand reporting abuse and neglect