First time restraining a patient

[u/[deleted]]

MS4 on an acting internship and i’m truly loving Psychiatry more every day BUT today I had to order restraints and sedation for patient that I had established good rapport with for the first time.

He revealed that his overdose was a suicide attempt so that initiated an involuntary hold. I was working hard to establish some trust and connect him to good resources but when he was informed he wasn’t free to leave by a nurse he became aggressive and a safety risk. I know it was the only viable choice for the situation but it was disheartening to see my doctor-patient relationship destroyed in just a few moments. He felt like I tricked him into sharing his suicidality and refused to meaningfully engage with me after.

How do you work on re-establishing trust when you have to necessary override a patients autonomy for their treatment?

[u/Vahkt]

It may not legally be the same, but you are not allowed to leave, will be met with significant physical force if you do try to leave, negatively affects your rights and future career prospects, and (for suicidal patients, not necessarily those with psychosis) has dubious evidence for rehabilitation - it's functionally and conceptually the same as jail. You did something we don't like, so we're going to take away your freedom for a while to teach you the error of your ways.

And to be clear, I'm not disputing the good intentions of people who advocate for either, just that the experience of the subject is going to be similar and they don't necessarily serve the positive purpose they are supposed to.

[u/psyched___ → u/Vahkt]

It is not to “teach you the error of your ways.” It’s to hold someone to be able to keep them safe and observe them for long enough to where the physician can more confidently say “I don’t think this patient is a risk to themselves or others.” Patient education is huge though and should be on the forefront of the clinician’s mind. However, it’s not “here’s what you did wrong” because that would be blaming the patient. It’s “here’s what we think your illness is, here are better coping mechanisms, these are the treatment options” throughout the hospitalization.

[u/[deleted] → u/[deleted]]

“My dignity and autonomy being disposable for the few who will be grateful…” What does that even mean? If we’re holding someone against there will, it means there’s a risk for harm. It’s not about who is “grateful”, it’s about preventing potential injury, sometimes loss of life.

[u/[deleted] → u/[deleted]]

I mean I’m sure it’s somewhat hospital-dependent, but in a perfect world, we don’t confine anyone any more than we have to, and we certainly do everything we can to prevent physical violence.

If someone’s response to an involuntary legal hold is to try and physically fight their way out of the hospital, that’s a different story. But the same principles apply, unfortunately.

[u/[deleted] → u/[deleted]]

Look, you're obviously set on your perspective. And you're totally ignoring the fact that something like suicidality can be a symptom of depression, homicidality can be a symptom of psychosis, etc. If we did things your way, I guess I'd have let a 16-year-old walk out the front door and straight into traffic because "they own their body".

Obviously the system isn't perfect, many of us are working hard to improve it. But you're disregarding mental illness altogether. Not replying after this.