How to Navigate a Mental Health Emergency
Living with Parkinson's can sometimes include the experience of co-occurring depression, anxiety, substance abuse or psychosis. While these mental health conditions can certainly be managed in outpatient (office) settings, there can be times when symptoms are severe enough to warrant an emergency evaluation.
In my work as a Psychiatric Emergency Room Clinician, I routinely assess individuals in mental health crisis and provide recommendations for the most appropriate level of care. If these terms sound foreign to you, you're not alone! I'm here to demystify an experience I hope you or your loved one never has to go through but nevertheless is good to be informed about ahead of time. In my practice assessing individuals with Parkinson's who sometimes present to the ER, it can be useful to have basic information about mental health emergencies.
What constitutes a mental health emergency?
- Suicidal thoughts that are new or imminent. For example: You begin to experience thoughts about ending your life with a specific plan. You are very concerned, that without support, you may act on this plan. Even if a plan isn't developed, new suicidal thoughts alone are a reason to touch base with a qualified medical provider. Your doctor or therapist can guide you in how to manage this further. If there's immediate concern for safety, call 911 or present to the emergency room.
- Notable decline in functioning. You may notice that you're having trouble taking showers, getting things done around the house, cooking and cleaning, and making it to scheduled events unrelated to physical impairment. This change in behavior can indicate that you mental health condition is worsening. It's common that a loved one may notice this before you. For example: Your loved one tells you that it's been five days since you've showered and they're wondering what's been getting in the way. You can't think of a good reason other than the very thought of taking care of yourself brings up feelings of mental exhaustion.
- Bizarre behavior: Signs of psychosis can include becoming more paranoid (i.e. suspicious) of other people, including ones you would typically trust, auditory hallucinations commonly referred to as "hearing voices", and/or visual hallucinations. For example: Your loved one notices you've been having trouble leaving the house for fear of running into the FBI who are monitoring you. Your loved one has also noticed you talking aloud apparently to yourself.
- Violent behavior: Aggression towards a loved one or care staff can indicate there needs to be a mental health evaluation. While this can be a very traumatic experience for both a person with Parkinson's and their family, behavioral changes such as this can be effectively treated and managed in appropriate settings. Like suicidality, this type of concern warrants (at the least!) a call to a medical or mental health professional to guide you. If there's immediate concern for safety, call 911 or present to the emergency room.
- Desire to stop using alcohol after heavy drinking: Immediately stopping alcohol use after heavy use can be highly dangerous and sometimes lethal. It is important that one goes through a supervised medical detox upon making the brave decision to seek treatment for this addiction.
What to expect when coping with a mental health emergency
- If your doctor or mental health professional recommends that you go to the ER to be evaluated it is natural to feel overwhelmed and scared. It's highly recommended that a loved one go with you for support and to provide valuable information to your medical team.
- Once at the ER, you will be asked questions by multiple members of a medical team which typically includes nurses, medical doctors, psychiatrists, and sometimes a social worker. Every hospital is different, but these are the disciplines that are typically involved.
- If you are at the hospital for a mental health concern, there are general measures taken to keep both you, your loved ones, and the medical team safe. These may include going through a metal detector and/or being kept in a room free of objects that could be of harm.
- You will receive a mental health assessment with the primary focus of determining what is the primary issue and what is the most appropriate level of care would be to treat it. The levels of care include: inpatient (hospital/staying overnight), partial hospitalization (coming to the hospital during the day for therapy, medication management, and group therapy), intensive outpatient (similar to partial hospitalization except for a shorter duration and time) and outpatient (weekly visits with mental health professionals).
It may be useful to know, if the recommendation is made for inpatient level of care, that not all hospitals provide this type of treatment so you may be referred to and transferred to a different hospital for the most appropriate care. In some states, there are freestanding psychiatric emergency rooms which are highly trained in how to manage mental health emergencies and can provide care on-site. These are some general guidelines which are in no way designed to constitute medical advice; they are intended to help you learn more about navigating through the mental health system.
It sometimes can be helpful to have a plan in place with your doctor or therapist and caregiver so if a crisis occurs, you can be as prepared as possible. My hope is that you will feel as empowered dealing with mental health concerns that can arise with Parkinson's as any other aspect of the disease.
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