Psychiatry and their interaction with Security

[ghost dog]

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As Psych likely has a significant amount of interaction with security in the inpatient setting, I was wondering if people could give me some insight on these workers.

I actually treated a security guard of a major hospital recently; and well, it was actually quite frightening what showed up in her urine drug screen.

I hope she was an exception, rather than the rule. Are security personnel required to submit to random UDS ( for employment )?

Having observed security in the ER setting , it doesn't appear that they are very skilled at 'de-escalating' sitations. It seems they are more inclined to do the opposite.

 

[whopper]

My interactions with security, or in one of the hospitals I work at, a forensic facility where actual police guards are the security have been very good.

I've seen situations where the relationship is strained and not well, but not in the places I worked at. This is definitely something to consider when working at a place. If security can't be counted on, your safety and the safety of your patients is in unreasonable risk.

 

[WhoisJohnGalt]

As Psych likely has a significant amount of interaction with security in the inpatient setting, I was wondering if people could give me some insight on these workers.

I actually treated a security guard of a major hospital recently; and well, it was actually quite frightening what showed up in her urine drug screen.

I hope she was an exception, rather than the rule. Are security personnel required to submit to random UDS ( for employment )?

Having observed security in the ER setting , it doesn't appear that they are very skilled at 'de-escalating' sitations. It seems they are more inclined to do the opposite.

I have always had very positive interactions with our police officers, but I work at a VA with a police force, and a university that is large enough to have an actual police department. At my moonlighting gig we have security, but so far all the patients that actually need "security" have been accompanied by police officers or sheriffs. All of whom have done an excellent job in de-escalating patients (often a better job than I can do) and making me feel safe. So IMO, 😍 to the cops, though to be fair I probably have a skewed pool and have interacted with more people that are especially trained in mental health.

 

[whopper]

I knew of two situations where there were major problems with security. Two attendings I worked with as a resident told me that in the prison system, several of the guards are literal bullies. If you cross them (and something as simple as the way you dress could be considered such), if you are attacked, they'll help you, but they'll wait a few minutes while you soak in a few punches, instead of react immediately so they won't get in trouble.

I also knew of an attending, and again this was the prison system, where the guards actually told him to start providing Ativan to the prisoners, so they could take the Ativan from them. The prisoners in-turn got a payout. The attending refused and his tires were slashed by the prison guards. Since it was the prison guards who were the acting police on the prison grounds, when he reported the incident, they looked the other way.

The other situation was in an very old long-term facility that was pretty much on the order of a dungeon. The employees barely did their jobs and whenever they didn't get what they wanted, they openly complained, even to the patients. While I was there, doing a rotation as a resident, a patient was on a two-to-one observation because staff members often, while on a one-to-one were known to walk away from the patient for extended periods of time. Even on the two-to-one the patient committed suicide. They let him in a bathroom all by himself and out of sight (even though the regulations stated he had to be in line of sight even in the bathroom). After an hour passed, the two bozos finally figured out something was likely up, checked up on him and he was dead, hanging from a belt he was not supposed to have in the first place.

At this same facility, security could not be counted on to do their job on all units.

The incident caused a big backlash against the state who sent several "top people" to look into the problem. Their solution? Spend millions on things that wouldn't have prevented the problem in the first place such as metal detectors. As far as the public's concerned, millions were thrown at the problem, problem solved. Go figure.

 

[ghost dog]

My interactions with security, or in one of the hospitals I work at, a forensic facility where actual police guards are the security have been very good.

I've seen situations where the relationship is strained and not well, but not in the places I worked at. This is definitely something to consider when working at a place. If security can't be counted on, your safety and the safety of your patients is in unreasonable risk.

I would think this would be a fairly unusual situation (i.e. Police working as security). It's my impression that police officers are quite rigorously screened psychologically, at least in comparison to your typical hospital security guard.

 

[whopper]

It's my impression that police officers are quite rigorously screened psychologically, at least in comparison to your typical hospital security guard.

Police officers are screened well, but no system is perfect. IA for example will do background checks, possibly even contact former employers, friends, family, etc.

Still, there will still be plenty of bad guys that get through the cracks. A former best friend (and there's a reason why he's a former) became a cop and within the first few days told me of all the brothels in the area where he worked that had to give out free sex to cops to keep in operation. He told me that since I was his friend, I was in on the free sex and he was going to fully exploit his benefits.

(Long story. Let's just say when a friend has a sexual addiction problem, and a guy like me and him were only in our teens to early twenties it was funny. When we hit our late 20s, he still has the problem, he got kicked out of law school while dating over 8 women, doctor-shopped to be diagnosed with ADHD to get back in, was engaged over 5 times, committed statutory rape several times, and boasting that his psychotherapist that I insisted he go to wanted to have sex with him.....I got a call from him telling me exactly what to say if IA called me about his past when he was in the process of becoming an officer. It was a major embellishment on the truth. I told him no way. First time it hit me that I really needed to distance myself from my buddy of over a decade despite years of attempts to get him on the straight and narrow..)

 

[TSasser]

I would think this would be a fairly unusual situation (i.e. Police working as security).

Might not be as unusual as you think. In Palm Beach County, FL (were I am originally from) it isn't to unusual to have police as security in hospitals. Granted most of them are moonlighting but some are hired or provide full time security. I have also seen this in Charlotte, NC.

Some hospitals won't even consider you for hire without having passed B.L.E.T. and are state certified.

 

[nitemagi]

I've never had any problems and have gotten to know security and police well at 5 different settings. VA has VA police (federal police), academic unit has hired security, jail had sheriff's deputies, county ER had hired security (ex-military), County Urgent Care (different county) has a mix of deputies and security. Never had any problems. Most of them are respectful and as long as you're up front about what's happening and are respectful of them, they're incredibly helpful. Even if they disagree with what you're doing.

Prison's seem like a much more entrenched institution, and I could see how that could be totally different.

 

[TSasser]

Prison is definitely a different world, use to work in one as a CO trainee while going through training.

 

[sunlioness]

I also knew of an attending, and again this was the prison system, where the guards actually told him to start providing Ativan to the prisoners, so they could take the Ativan from them. The prisoners in-turn got a payout. The attending refused and his tires were slashed by the prison guards. Since it was the prison guards who were the acting police on the prison grounds, when he reported the incident, they looked the other way..

Ugh. I had a patient today who told me, "The guy who invented benzodiazepines is a hero!" precisely at the same moment I was thinking (yet again), "The guy who invented benzodiazepines needs to be taken out and shot." 😡

I haven't had any problems with security.

 

[ghost dog]

Ugh. I had a patient today who told me, "The guy who invented benzodiazepines is a hero!" precisely at the same moment I was thinking (yet again), "The guy who invented benzodiazepines needs to be taken out and shot." 😡

I haven't had any problems with security.

Imagine if we were practicing 30 years ago, and barbs were still in vogue😱

 

[CaMD]

When I was on the consult service and spending my time on the non-psychiatry floors, I actually kind of liked seeing the security guards hovering outside a room. Made me feel more "at home." 🙂

 

[Manicsleep]

I have always had very positive interactions with our police officers, but I work at a VA with a police force, and a university that is large enough to have an actual police department. At my moonlighting gig we have security, but so far all the patients that actually need "security" have been accompanied by police officers or sheriffs. All of whom have done an excellent job in de-escalating patients (often a better job than I can do) and making me feel safe. So IMO, 😍 to the cops, though to be fair I probably have a skewed pool and have interacted with more people that are especially trained in mental health.

The VA police force is highly unusual in that they are very respectful, well trained, good with patients and surprisingly effective at avoiding becoming agitated themselves.

 

[Doctor Bagel]

The VA police force is highly unusual in that they are very respectful, well trained, good with patients and surprisingly effective at avoiding becoming agitated themselves.

I think the big thing with the VA is that they actually are police, not just random security guards, so selection process is somewhat better. Of course the police in my city like to shoot mentally ill people fairly regularly, so maybe that's not so reassuring. 😱

 

[sunlioness]

Imagine if we were practicing 30 years ago, and barbs were still in vogue😱

I actually had a patient this week ask me for one of those, too. He said his grandma took it.

 

[masterofmonkeys]

Jail and VA have been great. Then again they are sheriff's deputies and police. Security has been a mixed bag. My biggest problem with security is when they send someone who is scared by psychotic patients, which happens all too regularly.

 

[DD214_DOC]

How involved are you guys with codes for agitated patients? Here, we are expected to actually put hands on a patient and assist with take downs, which seems completely ridiculous to me.

 

[Doctor Bagel]

How involved are you guys with codes for agitated patients? Here, we are expected to actually put hands on a patient and assist with take downs, which seems completely ridiculous to me.

That's pretty atypical, I think. At the state hospital, it seems like the physicians show up and are involved in things like "show on concerns" where all the staff gather around a patient to try to convince them to do something. My understanding is that being peripherally involved in take downs happens sometimes, but I don't think physicians are supposed to be primary players. At the other places I've rotated at, I don't think we're supposed to be physically involved at all.

 

[Sneezing]

Every so often I thank the police and security at my institution. They do their job very well and I try to remember to thank them. Once, thankfully because they were already right there, they kept a patient from pummeling me after I broke the news they had to go to their home county psych ward and not the one here in the big city they wanted. I can't remember if the patient threatened to kill me or not but they were threatening great bodily harm! The punch got about 6 inches from my face.

On our psych floors we mostly have an over supply of small petite nurses. They aren't the best for restraining agitated patients! So one of my old school attendings would recruit me to go help him. Even when security would show up on these units they'd some times need extra hands. Usually it was at night on call when there was less security that a helping hand would be needed.

One instance I got to that specific unit while being on call to see enough people were there with nursing and security to handle it. I went to take care of the restraint orders and start documenting the incident. The old attending showed up and helped out the restraining and on the way out gave me a look of dissapointment for not assissting with the patient.

Discussing the issue with the old attending and even my own thoughts now are if the patient is crossing *that line* and really needs restraints 5 minutes ago and I have the slightest concern for the nurses I'm going to help out. The vast majority I don't assisst with. Over the years I've heard, seen, and treated different people who had worked on psych floors and differing degrees of injuries from them that were nothing to disabling. No one deserves to be disabled from working on a psych unit. Just a tragedy.

Mind you I'm a bigger guy so expecting the petite female residents to assist is different. I do have to say the very few times I have done this have been an educational experience. It has allowed me to grow and be more athorative when telling a patient their behavior is innapropriate and presenting the front of no fear.

I witnessed this old attending once simply stand up to an antisocial who was becoming beligerent and threatening. The patient came in closer to the attending (well within in the bubble of personal space) and was posturing for violence. The old attending showed no fear, stood his ground and told him he was innapropriate. The patient backed down and wasn't a problem. The lesson for us residents was that some people who've lived on the street their whole life are used to confrontation and will respond to fear and use violence as a tool to get their way. Not showing it lets them know you won't stand for their shenanigans.

 

[DD214_DOC]

That's pretty atypical, I think. At the state hospital, it seems like the physicians show up and are involved in things like "show on concerns" where all the staff gather around a patient to try to convince them to do something. My understanding is that being peripherally involved in take downs happens sometimes, but I don't think physicians are supposed to be primary players. At the other places I've rotated at, I don't think we're supposed to be physically involved at all.

I've been to several hospitals where the docs aren't there at all, just available if meds need to be given/ordered (and PRN code greys are usually already ordered).

I don't know why people assume that, since we're shrinks, we have some innate ability to talk down an agitated and unreasonable person any better than anyone else who has had training. I'm quite certain that everything we learn is intended for the rational, thoughtful person.