On Fridays I will address a basic psychiatric question and find the answer from an expert. If you have a question you want answered, please ask it on the combox of this post, and I’ll try my best to do some research and feature it in an upcoming Friday post.

The NAMI Maryland publication, “Connections,” recently published this question:

I was recently faced with the dilemma of whether or not my wife was a danger to herself and others, and whether or not to take her to the emergency room as a psychiatric emergency. Are there any guidelines or suggestions as to when its best to take a loved one to the hospital?

Dr. Mark Komrad, M.D. responded:

This is one of the challenging issues in all of psychiatry–both practically and ethically. So I can only attempt to address it in a most preliminary fashion in this article. The easy answer is: call your wife’s psychiatrist. I believe that all physicians should have a system to be available in the case of possible emergency. That is a fundamental ethical principle we are taught in medical school. Every patient and family should be familiar with how to contact the psychiatrist in the case of emergency.

One of the most common reasons psychiatrists are reached in an emergency is to consult on just this situation–whether or not a person should go to an emergency room (ER). As a part of residence training, all psychiatrists have extensive experience with this scenario.

What if the doctor can’t be reached or if there is no psychiatrist on the case … yet? The primary concern is safety–hers and yours. If there is any question that your wife is unable to control her behavior to maintain safety, it is reason enough to have an evaluation in the ER. Safety includes considerations of violence to self and others, as well as other kinds of safety such as fire safety, fall risk, or medical risk. A diabetic who is refusing to eat, a person with unstable hypertension who is highly agitated, a person who has fallen into an unmoving catatonia and isn’t acting to take care of his basic needs, a person who environment has deteriorated to a fire or health hazard: these are all examples of various cases from my own clinical experience that have been appropriately brought to the ER. So, if the doctor says go–go. If you feel there is a risk of harm afoot -go.

A final consideration in your decision: if someone has never been in for treatment, an ER evaluation can open the door to mental health treatment, and is sometimes the only first step a person is willing to take.

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