Psychologist taking patients off suicide precaution.

[BorderlineQueen]

Op-Ed: Replacing psychiatrists in jails is dangerous

The Justice Department has acknowledged that Jeffrey Epstein, who died by suicide while awaiting trial on charges of sex trafficking, was taken off

www.theintell.com

Just wondering what your thoughts are on this article. I’ve interacted with two psychiatrists and multiple physicians who had stated psychologists learn suicide risk assessments from internet videos. Some have also said psychologists do not even have the right training to diagnosis and treat mental illness. I think it’s definitely a little too out there to think a psychiatrist would have made a different decision.

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[psych.meout]

 

[BorderlineQueen]

View attachment 278843

Not really the response I’m looking for.

 

[AbnormalPsych]

My thoughts are that it is insulting, careless, misleading to the public, and harmful to our profession.

That aside, I am curious if anyone with a corrections background on here can share what the criteria are for being placed on "suicide watch" and other available options. Outcome aside, I think there is a public overreaction here regarding the procedures, given that (at least I) have no idea how that evaluation went and how such decisions are made in the correctional system.

 

[AbnormalPsych]

I do find it problematic that psychologists may be interfering with medication. I think this is where a team approach is very valuable between psychiatry and psychology. I also find it problematic that an unlicensed psych trainee overrules a psychiatrists orders, but I doubt that's the full story.

 

[PikminOC]

There are many np now I think working in prison system

 

[BorderlineQueen]

There are many np now I think working in prison system

This is very true I know many NPs working in the prison system who have taken patients off suicide watch. Have not seen any articles against this even though most of them have less training than both psychiatrist and psychologists.

 

[Sanman]

I know how the author feels, I hospitalized a psych patient who was an imminent risk of injuring himself in an LTC. He was paranoid his wife was cheating on him at home and wanted to slit his wrists with a knife. Some undertrained yahoo overruled that assessment and sent him back to the facility. 24 hrs later he slit his wrists and was re-admitted. That was the apparently undertrained... hospital staff psychiatrist.

Poorly trained clinicians come in all shapes, sizes, and degrees.

 

[BuckeyeLove]

I did it for a few years working in corrections.

 

[BorderlineQueen]

I did it for a few years working in corrections.

Okay but did you read the article? Thoughts ?

 

[PsyDr]

Blaming the psychologist is stupid.

Epstein attempted suicide on 7/23. He was held on suicide watch until approximately 7/29-7/30. Suicide watch included daily suicide assessments. He was discharged from suicide precautions. 10 days go by without incident. On 8/10 Epstein committed suicide. His fellow prisoners openly state that they believed Epstein lied to get off restriction.

There is not a single hospital in the USA that would hold someone against their will for 10 days because the patient expressed suicidal ideation 10 days ago. The laws in most states would make doing so a felony for the attending, for the non incarcerated.

Even if one ignores the actual timeline, the literature on suicide assessments would show that prediction is almost impossible. And if one is aware of the literature about clinical judgement to detect lying, one would not point fingers at the psychologist either.

If one looks at the literature and facts, best case scenario is that the psychologist use the best tools available which the literature says are basically meaningless. The patient lied to him/her and the literature says there’s basically no real way to determine that. Then the patient killed himself 10 days later.

Any professional who holds that psychologist liable is either misinformed or is purposely ignoring facts.

Imagine if you had a patient tell you they were fine, and then they committed suicide 10 days later. Would you think you did something wrong?

This is the same bs as Princes estate trying to sue an ER for giving him a days supply of painkillers 2 weeks before he ODed.

 

[Mad Jack]

Op-Ed: Replacing psychiatrists in jails is dangerous

The Justice Department has acknowledged that Jeffrey Epstein, who died by suicide while awaiting trial on charges of sex trafficking, was taken off

www.theintell.com

Just wondering what your thoughts are on this article. I’ve interacted with two psychiatrists and multiple physicians who had stated psychologists learn suicide risk assessments from internet videos. Some have also said psychologists do not even have the right training to diagnosis and treat mental illness. I think it’s definitely a little too out there to think a psychiatrist would have made a different decision.

Do psychologists have years of training in inpatient and emergency psychiatry that would prepare them specifically for the sort of risk assessment required of a patient like this?

Most of my patients lie because they want to attempt again, learning to read which ones are and are not BSing you is an art more than a science and really requires structured training to develop a decent degree of skill with regard to.

 

[PsyDr]

Do psychologists have years of training in inpatient and emergency psychiatry that would prepare them specifically for the sort of risk assessment required of a patient like this?

Most of my patients lie because they want to attempt again, learning to read which ones are and are not BSing you is an art more than a science and really requires structured training to develop a decent degree of skill with regard to.

1) Most are.

2) how would you reconcile your opinions about your lie detection ability with the empirical literature? Say if you were criminally charged or sued for keeping someone against their will and they were denying SI?

 

[DynamicDidactic]

Taking this out of the Epstein realm.

My observation, as a suicide researcher, is that the whole system provides very poor treatment for individuals at high-risk for suicide.
A) Everyone seems to be poorly trained.
B) Psychiatrists and psychiatric nurse practitioners are overly restrictive and default to hospitalization. Emerging data indicates that this may actually be iatrogenic.
C) Psychologists are too permissive and rely on safety plans while rarely providing evidence-based treatment.
D) Correctional facilities are not places that will provide useful help to suicidal individuals (or any mental health problems).

That Op-Ed is full of logical fallacies and lacking any evidence. Simply put, despite some well-known risk factors we cannot predict who will make a suicide attempt (and especially death). Correctional facilities are particularly dangerous places for suicide (I believe about 4X greater risk than general population). Let's not rely on the Epstein situation to somehow be representative of the greater issues.

 

[cara susanna]

Maybe if this lady were a psychologist with training in assessment she'd know that our ability to predict actual suicidal behavior is pretty poor.

Edit: Also, psychiatrists have significantly more training than psychologists? What?

Double edit: Whoops, the author is female.

 

[BorderlineQueen]

Maybe if this dude were a psychologist with proper training in assessment he'd know that our ability to predict actual suicidal behavior is pretty poor.

Nope just an MD that thinks MDs=god tier and everyone else knows nothing.

 

[psyc0100]

1) Most are.

2) how would you reconcile your opinions about your lie detection ability with the empirical literature? Say if you were criminally charged or sued for keeping someone against their will and they were denying SI?

Your belief is that "most" psychologists have years of inpatient training? I'm sorry?

Have you ever worked inpatient? I've worked at several and let me assure you, hospitalization for 10 days following expression of suicidal ideation is far from unusual. Can you please explain to me how "most" psychologists have multiple full years of inpatient experience, and would you mind sharing what yours is for reference?

 

[cara susanna]

Lol, I just saw that the author is a family physician, not even a psychiatrist.

 

[DynamicDidactic]

@cara susanna I think dude is a non-gender-specific term

 

[Ollie123]

For starters, anyone who knows <anything> about suicidal behavior and believes we can predict who will do what with 100% accuracy (or anything close to it) is an idiot not worth hearing. Doubly so if they believe their clinical interview of someone in a forensic setting is what will allow for it.

I am going to guess that the "Psychologists learn about suicide assessment from online videos" nonsense was the training modules for the CSSRS. Its not learning how to do evaluation, its learning one specific module that they require completion of for one specific assessment to help ensure standardized administration.

I don't know a single psychologist whose training consisted solely of those videos. I do know plenty of physicians (but still a minority of them!) who learned from one senior physician on the wards who tried to pass along their magical "intuitive" assessment skills that I'm totally 100% sure they had carefully empirically validated over many decades and would beat any standardized assessment tool in a heartbeat to justify a paper in JAMA, but who has time for science?

 

[Mad Jack]

1) Most are.

2) how would you reconcile your opinions about your lie detection ability with the empirical literature? Say if you were criminally charged or sued for keeping someone against their will and they were denying SI?

The legal mechanisms for holding patients in my state require oversight and intervention by a judge after a determination for additional treatment has been made. As the laws are structured to err on the side of protecting patients that are a danger to themselves, preliminarily determining someone to be a likely threat to themselves places them in a psychiatric hold until a judge reviews the case to determine the need for treatment. The structure of the legal process leaves little room for lawsuits due to false imprisonment and the like, as you are merely making a recommendation for a judge to review and choose to act upon or rescind.

With regard to suicides, we use standardized instruments to gauge suicidal ideation, but they are more likely to be confirmatory of a positive need for treatment than they are to rule out the need for treatment, so even a negative result on standardized tools of evaluation can be overridden by a statement that delves into the patient's reliability as a historian or the patient's collateral information conflicts with their given information. There is no way to prevent 100% of suicides, and while I have yet to have one on my watch, they have happened in my community. When they occur, you justify yourself by documentation of the standardized tools utilized, the collateral obtained, the patient history, etc. We don't let a patient go without family and/or community involvement and collateral, and if anyone is uncomfortable in the process we tend to err toward admission. This approach has resulted in zero lawsuits against any of our local psychiatrists in the last 30 years for suicide/ wrongful death, so I would say at least in my area we are approaching things well enough.

 

[PsyDr]

Your belief is that "most" psychologists have years of inpatient training? I'm sorry?

Have you ever worked inpatient? I've worked at several and let me assure you, hospitalization for 10 days following expression of suicidal ideation is far from unusual. Can you please explain to me how "most" psychologists have multiple full years of inpatient experience, and would you mind sharing what yours is for reference?

1) no need to be sorry.

2) I do believe most psychologist receive training in inpatient settings, but that was not the question. Inpatient psychologist work wasn’t even the question. Experience specifically wasn’t even the question. Even if it was, the clauses required psychiatry work. The question was if psychologists have sufficient training for this type of assessment. The answer is yes.

3) I am or have been a neuropsychologist at multiple hospitals including general and psychiatric. I retain a position in one or two of those to date.

 

[WisNeuro]

I've only ever worked in positions with an inpatient component. Hospitalization for SI for more than stabilization is extremely uncommon. The only reason that someone is hospitalized longer them 72 hours with SI is if they also have another acute exacerbation, most often with a psychotic disorder, or medical problem causing a delirium or similar issue. If someone presented with only SI and accompanying anxiety/depression, they would be stabilized and sent out with a referral or OP treatment. If someone consistently denied SI, 99.99% of the time they would be sent out that same day.

I'd like to see these hospitals that have the luxury of unlimited IP bed space to keep SI patients for that long. Where is this magical hospital? Most metro areas I've worked have to coordinate with other hospitals to see when and where beds open up to turf patients too as the census is almost always 95-100% full.

 

[PsyDr]

The legal mechanisms for holding patients in my state require oversight and intervention by a judge after a determination for additional treatment has been made. As the laws are structured to err on the side of protecting patients that are a danger to themselves, preliminarily determining someone to be a likely threat to themselves places them in a psychiatric hold until a judge reviews the case to determine the need for treatment. The structure of the legal process leaves little room for lawsuits due to false imprisonment and the like, as you are merely making a recommendation for a judge to review and choose to act upon or rescind.

With regard to suicides, we use standardized instruments to gauge suicidal ideation, but they are more likely to be confirmatory of a positive need for treatment than they are to rule out the need for treatment, so even a negative result on standardized tools of evaluation can be overridden by a statement that delves into the patient's reliability as a historian or the patient's collateral information conflicts with their given information. There is no way to prevent 100% of suicides, and while I have yet to have one on my watch, they have happened in my community. When they occur, you justify yourself by documentation of the standardized tools utilized, the collateral obtained, the patient history, etc. We don't let a patient go without family and/or community involvement and collateral, and if anyone is uncomfortable in the process we tend to err toward admission. This approach has resulted in zero lawsuits against any of our local psychiatrists in the last 30 years for suicide/ wrongful death, so I would say at least in my area we are approaching things well enough.

While I am glad that you have not been sued, that did not answer my question.

How do you reconcile your statements indicating you can read someone who is not telling the truth with the empirical literature which says otherwise?

 

[psych.meout]

The legal mechanisms for holding patients in my state require oversight and intervention by a judge after a determination for additional treatment has been made. As the laws are structured to err on the side of protecting patients that are a danger to themselves, preliminarily determining someone to be a likely threat to themselves places them in a psychiatric hold until a judge reviews the case to determine the need for treatment. The structure of the legal process leaves little room for lawsuits due to false imprisonment and the like, as you are merely making a recommendation for a judge to review and choose to act upon or rescind.

With regard to suicides, we use standardized instruments to gauge suicidal ideation, but they are more likely to be confirmatory of a positive need for treatment than they are to rule out the need for treatment, so even a negative result on standardized tools of evaluation can be overridden by a statement that delves into the patient's reliability as a historian or the patient's collateral information conflicts with their given information. There is no way to prevent 100% of suicides, and while I have yet to have one on my watch, they have happened in my community. When they occur, you justify yourself by documentation of the standardized tools utilized, the collateral obtained, the patient history, etc. We don't let a patient go without family and/or community involvement and collateral, and if anyone is uncomfortable in the process we tend to err toward admission. This approach has resulted in zero lawsuits against any of our local psychiatrists in the last 30 years for suicide/ wrongful death, so I would say at least in my area we are approaching things well enough.

Ooh, an anecdote, how scientific!

 

[psyc0100]

1) no need to be sorry.

2) I do believe most psychologist receive training in inpatient settings, but that was not the question. Inpatient psychologist work wasn’t even the question. Experience specifically wasn’t even the question. Even if it was, the clauses required psychiatry work. The question was if psychologists have sufficient training for this type of assessment. The answer is yes.

3) I am or have been a neuropsychologist at multiple hospitals including general and psychiatric. I retain a position in one or two of those to date.

The question was "Do psychologists have years of training in inpatient and emergency psychiatry that would prepare them specifically for the sort of risk assessment required of a patient like this?" and I think it's naive to say MOST, as in, the literal majority have YEARS of psychiatric and or inpatient experience.

I've only ever worked in positions with an inpatient component. Hospitalization for SI for more than stabilization is extremely uncommon. The only reason that someone is hospitalized longer them 72 hours with SI is if they also have another acute exacerbation, most often with a psychotic disorder, or medical problem causing a delirium or similar issue. If someone presented with only SI and accompanying anxiety/depression, they would be stabilized and sent out with a referral or OP treatment. If someone consistently denied SI, 99.99% of the time they would be sent out that same day.


I'd like to see these hospitals that have the luxury of unlimited IP bed space to keep SI patients for that long. Where is this magical hospital? Most metro areas I've worked have to coordinate with other hospitals to see when and where beds open up to turf patients too as the census is almost always 95-100% full.

There's nothing "magical" about it, in my years in UHS private psyc hospitals with 150 beds they are virtually never full and they commonly keep people for weeks with minimal basis. We had maybe one day per 6 months that we had 100% beds full and we all got pizza for it. I will say the child/adolesc beds were pretty much always full, but not adults.

The fact that you've worked in hospitals and VAs with a 12/16 bed inpatient subunit hardly qualifies you to speak to the realities of private psychiatric hospitals which so proliferate.

 

[str63]

The question was "Do psychologists have years of training in inpatient and emergency psychiatry that would prepare them specifically for the sort of risk assessment required of a patient like this?" and I think it's naive to say MOST, as in, the literal majority have YEARS of psychiatric and or inpatient experience.



There's nothing "magical" about it, in my years in UHS private psyc hospitals with 150 beds they are virtually never full and they commonly keep people for weeks with minimal basis. We had maybe one day per 6 months that we had 100% beds full and we all got pizza for it. I will say the child/adolesc beds were pretty much always full, but not adults.

The fact that you've worked in hospitals and VAs with a 12/16 bed inpatient subunit hardly qualifies you to speak to the realities of private psychiatric hospitals which so proliferate.

Perhaps things are different at UHS hospitals? It is extremely uncommon for patients to stay longer than a few days for SI at all the inpatient units in my area, including those with 100+ beds. The initial question isn't necessarily straight forward as there are 2 parts (years of training in inpatient and emergency psychiatry vs. prepared for suicide risk assessment). I do think psychologists are (and should absolutely be) prepared for suicide risk assessment. Do you think psychologists aren't able to do suicide risk assessment?

 

[Mad Jack]

While I am glad that you have not been sued, that did not answer my question.

How do you reconcile your statements indicating you can read someone who is not telling the truth with the empirical literature which says otherwise?

I just do my best. As a physician you have to make decisions, and you know that some will not be correct, but you have to have faith in your ability to make them regardless in order to avoid having your decisions controlled more by fear than reason.

 

[Mad Jack]

Ooh, an anecdote, how scientific!

I mean, there is no scientific method to lie detection that has ever been sufficiently proven to work. This isn't science, this is the art of dealing with other human beings. Some people are certainly better at it than others, but no one is perfect. A you can do is try your best and cover your bases in a manner that keeps you from getting sued to the greatest extent possible.

 

[psych.meout]

I mean, there is no scientific method to lie detection that has ever been sufficiently proven to work. This isn't science, this is the art of dealing with other human beings. Some people are certainly better at it than others, but no one is perfect. A you can do is try your best and cover your bases in a manner that keeps you from getting sued to the greatest extent possible.

It's absolutely science. The literature indicates that the traditional risk factors approach doesn't work (only a small few factors are better than chance, which isn't saying much).

Appeals to "art" in psychology and mental health just allow people to eschew science when it's inconvenient.

 

[psych.meout]

I just do my best. As a physician you have to make decisions, and you know that some will not be correct, but you have to have faith in your ability to make them regardless in order to avoid having your decisions controlled more by fear than reason.

Ooh, art and faith, how scientific.

 

[jtpesek]

The question was "Do psychologists have years of training in inpatient and emergency psychiatry that would prepare them specifically for the sort of risk assessment required of a patient like this?" and I think it's naive to say MOST, as in, the literal majority have YEARS of psychiatric and or inpatient experience.



There's nothing "magical" about it, in my years in UHS private psyc hospitals with 150 beds they are virtually never full and they commonly keep people for weeks with minimal basis. We had maybe one day per 6 months that we had 100% beds full and we all got pizza for it. I will say the child/adolesc beds were pretty much always full, but not adults.

The fact that you've worked in hospitals and VAs with a 12/16 bed inpatient subunit hardly qualifies you to speak to the realities of private psychiatric hospitals which so proliferate.

Over a year in just internship with the adult acute suicidal unit and this UHS hospital’s Phoenix Unit (adolescent males) - provided some phenomenal training in suicidality - MORE SO than the acronyms learned in academic settings. Excuse my grammar errors - fat thumbs and iPhones

 

[WisNeuro]

There's nothing "magical" about it, in my years in UHS private psyc hospitals with 150 beds they are virtually never full and they commonly keep people for weeks with minimal basis. We had maybe one day per 6 months that we had 100% beds full and we all got pizza for it. I will say the child/adolesc beds were pretty much always full, but not adults.

The fact that you've worked in hospitals and VAs with a 12/16 bed inpatient subunit hardly qualifies you to speak to the realities of private psychiatric hospitals which so proliferate.

Methinks if you take a poll, you'll find that your experience is the exception, and very far from the rule in a majority of healthcare.

 

[PsyDr]

@psyc0100

1) Fair warning: I’ll argue till the cows come home.

2) You’re interpretation of the question is different than mine. There are several clauses in it. You seem to be focusing upon the “inpatient” part, while ignoring the “psychiatric” part. I’ll estimate that the number of individuals who are licensed as both psychologists and psychiatrists is so extremely small as to be a nothing in the data. So if the question is focused upon the first clause, the answer is basically none. If the questionfocuses upon the latter clause regarding outcome (which is arguably the point of OPs article), then the answer is most psychologists, because the outcome has basically nothing to do with the “inpatient and emergency psychiatry”.

3) You are aware that UHS remains the subject of a federal investigation regarding their practices of keeping patients longer than would be reasonable, right? Because they just settled for like $120MM with the department of justice for such practices. That might be the “realities of private psychiatric hospitals”. But it doesn’t help your appeal to authority.

@Mad Jack

1) that makes sense with the community standards of care. The OP article is basically saying that psychologists < psychiatrists in predicting suicide. I can see no literature supporting that. It’s just some guild stuff using national news.

 

[psyc0100]

Methinks if you take a poll, you'll find that your experience is the exception, and very far from the rule in a majority of healthcare.

@psyc0100

1) Fair warning: I’ll argue till the cows come home.

2) You’re interpretation of the question is different than mine. There are several clauses in it. You seem to be focusing upon the “inpatient” part, while ignoring the “psychiatric” part. I’ll estimate that the number of individuals who are licensed as both psychologists and psychiatrists is so extremely small as to be a nothing in the data. So if the question is focused upon the first clause, the answer is basically none. If the questionfocuses upon the latter clause regarding outcome (which is arguably the point of OPs article), then the answer is most psychologists, because the outcome has basically nothing to do with the “inpatient and emergency psychiatry”.

3) You are aware that UHS remains the subject of a federal investigation regarding their practices of keeping patients longer than would be reasonable, right? Because they just settled for like $120MM with the department of justice for such practices. That might be the “realities of private psychiatric hospitals”. But it doesn’t help your appeal to authority.

@Mad Jack

1) that makes sense with the community standards of care. The OP article is basically saying that psychologists < psychiatrists in predicting suicide. I can see no literature supporting that. It’s just some guild stuff using national news.

It was also my experience in the state hospital system, and is further the case in some non-UHS private systems (i.e. some parts of Rogers Memorial, Sheppard Pratt etc). If anything the state hospital was a thousand times worse than UHS, they straight up just forgot people in there a month at a time.

This forum should be called "crotchety narcissists who worked at VAs and now think they know everything about all settings in psychology.

 

[Mad Jack]

It's absolutely science. The literature indicates that the traditional risk factors approach doesn't work (only a small few factors are better than chance, which isn't saying much).

Appeals to "art" in psychology and mental health just allow people to eschew science when it's inconvenient.

Ooh, art and faith, how scientific.

Reading people is not a particularly quantifiable skill. Look at poker, a game that relies almost entirely on one's ability to read the intentions of others. On average, most people aren't very good at it, but some people are substantially better than that average. You can quantify the cards and the odds in certain forms of the game, but winning ultimately comes down to the rather unscientific ability to read and understand other people and to use that information accordingly. Not everything about the human experience can be quantified and enumerated, and generally I find the sorts that try to insist it can and should to be the types that typically seem to have insecurity about the field not being taken seriously if we ever dare refer to its more nebulous human elements. You can't objectively prove a person is in love, you can't show with certainty the perception of subjective human emotions such as anxiety and fear, and you can't quantifiably interpret the intentions of others based upon their statements alone.

Now, you get me a tool that can objectively measure whether someone is lying and I'll use it. But until that day, we are going to have to stick with good old fashioned people skills with screens basically just existing to provide legally defensible fluff for the record.

 

[msgeorgeeliot]

This forum should be called "crotchety narcissists who worked at VAs and now think they know everything about all settings in psychology.

Moo y’all

 

[psych.meout]

It was also my experience in the state hospital system, and is further the case in some non-UHS private systems (i.e. some parts of Rogers Memorial, Sheppard Pratt etc). If anything the state hospital was a thousand times worse than UHS, they straight up just forgot people in there a month at a time.

This forum should be called "crotchety narcissists who worked at VAs and now think they know everything about all settings in psychology.

I know you all hate dynamic/analytic theory but I do think it helps me see from a different conceptualization. We all hate @erg923 for being a rude, dismissive, condescending bully. But look at this - @PsyDr 's first response was to insult my standing without basis or accuracy as though that negated the objective reality of a particular path to loan repayment, after demeaning the OP as having a "personal chef" again without basis. @WisNeuro provides the helpful advice of telling them to expatriate as their life in America is done, @psych.meout joins to similarly deride comments without data while providing no data of his own and shares the condescending tone of others and @spagetti_jones goes on this insane reverse bernie sanders rant.

My point of this is that Erg is Jung's scapegoat. He represents the sins of the community toward which others cast their blame to distance themselves from their own reflection due to him representing these flaws somewhat more than others. In my opinion, all the "old guard" as stated of this board are mean-spirited, judgmental, counterproductive jerks who have no interest in helping others unless and until it bolsters their ego to do so.

 

[AbnormalPsych]

in my years in UHS private psyc hospitals with 150 beds they are virtually never full and they commonly keep people for weeks with minimal basis.

This forum should be called "crotchety narcissists who worked at VAs and now think they know everything about all settings in psychology.

I have worked in VA, AMCs, private hospital systems, private practice, private residential facilities, partial outpatient programs, and community mental health. I have been invovlved with inpatient work in many of these settings. Your experience does not generalize to any of my experiences across 4 states.

Methinks if you take a poll, you'll find that your experience is the exception, and very far from the rule in a majority of healthcare.

+1

Reading people is not a particularly quantifiable skill. Look at poker, a game that relies almost entirely on one's ability to read the intentions of others. On average, most people aren't very good at it, but some people are substantially better than that average. You can quantify the cards and the odds in certain forms of the game, but winning ultimately comes down to the rather unscientific ability to read and understand other people and to use that information accordingly. Not everything about the human experience can be quantified and enumerated, and generally I find the sorts that try to insist it can and should to be the types that typically seem to have insecurity about the field not being taken seriously if we ever dare refer to its more nebulous human elements. You can't objectively prove a person is in love, you can't show with certainty the perception of subjective human emotions such as anxiety and fear, and you can't quantifiably interpret the intentions of others based upon their statements alone.

Now, you get me a tool that can objectively measure whether someone is lying and I'll use it. But until that day, we are going to have to stick with good old fashioned people skills with screens basically just existing to provide legally defensible fluff for the record.

Spoken like an MD with no research training/approach to clinical work from a scientist-practitioner model.

Also, please don't compare psychiatric evaluations to bluffs in poker.

 

[Mad Jack]

I have worked in VA, AMCs, private hospital systems, private practice, private residential facilities, partial outpatient programs, and community mental health. I have been invovlved with inpatient work in many of these settings. Your experience does not generalize to any of my experiences across 4 states.



+1



Spoken like an MD with no research training/approach to clinical work from a scientist-practitioner model.

Also, please don't compare psychiatric evaluations to bluffs in poker.

I've done research and my program has a fairly strong research-based focus (I've got a handful of posters submitted to the APA conference this year and I'm working on two research projects in refractory depression and addiction psychiatry at the moment) but I think that there is a big push to neglect the human component of psychiatric evaluation and treatment. As someone who plans to focus on addiction, most of the patients in my core demographic are liars, and their screening results and answers to questions during evaluations are often designed to elicit particular responses in clinicians that will get them a desired outcome. Suicide risk assessment is often a similar situation- some patients lie in attempts to be admitted because they want a roof over their head and three meals a day, others lie to be discharged so that they can follow through with their intended actions. What is your evidence based approach to deal with lies that are multifactorial in nature and often require subtle reading of a psychosocial situation and verbal/physical cues to determine the veracity of?

 

[Mad Jack]

@psyc0100

1) Fair warning: I’ll argue till the cows come home.

2) You’re interpretation of the question is different than mine. There are several clauses in it. You seem to be focusing upon the “inpatient” part, while ignoring the “psychiatric” part. I’ll estimate that the number of individuals who are licensed as both psychologists and psychiatrists is so extremely small as to be a nothing in the data. So if the question is focused upon the first clause, the answer is basically none. If the questionfocuses upon the latter clause regarding outcome (which is arguably the point of OPs article), then the answer is most psychologists, because the outcome has basically nothing to do with the “inpatient and emergency psychiatry”.

3) You are aware that UHS remains the subject of a federal investigation regarding their practices of keeping patients longer than would be reasonable, right? Because they just settled for like $120MM with the department of justice for such practices. That might be the “realities of private psychiatric hospitals”. But it doesn’t help your appeal to authority.

@Mad Jack

1) that makes sense with the community standards of care. The OP article is basically saying that psychologists < psychiatrists in predicting suicide. I can see no literature supporting that. It’s just some guild stuff using national news.

I don't think that there is any reason to believe psychiatrists are any more qualified than a well-trained psychologist, so on that we agree. My general impression is that psychologist training is far more variable than psychiatrist training, so some psychologists likely have quite robust exposure to suicide risk assessment in emergency and correctional settings while others have far less, depending on the quality of the included rotations within a program, but that most programs provide adequate training in this regard.

 

[foreverbull]

Wow, this thread got intense.

This article blasts psychologists by saying they have less training by as little as one year (or up to 2-3), depending on length of program and postdoc. This is splitting hairs and the comparison may not be appropriate due to the different types of training (what if we excluded the years med students are learning general knowledge and doing unrelated rotations and not psychiatric diagnosis/treatment/etc.)?
The author also fails to discuss the nuances of training and education that psychologists receive compared to psychiatrists. She doesn’t have any data to back up her argument, but we’re supposed to accept it because she’s a medical doctor in an unrelated specialty? Hmmm....well, she is inherently superior with those credentials, right?

The reality is, clients lie, and we are expected to take them at their word and respect it. Certainly incompetence or malpractice can be a problem within psychology OR psychiatry practice, but so can overemphasizing responsibility of others involved in a client’s care. In my opinion, our culture is at the extreme of blaming every professional who had contact with the person who died by suicide rather than accepting that, sometimes, people are set on dying, and that’s their free will in action. In some cases, crisis intervention can turn some people’s lives around completely, but sometimes it doesn’t at all (a former client told me that his prior hospitalization was completely unhelpful and also ineffective, unless you consider vowing to kill yourself rather than being hospitalized again as “effective”). I hope our culture can come toward the middle on this issue someday and not externalize the blame in every case. People are complex, as is the issue. This author is taking the easy route by finding a scapegoat that fits her underlying biases.....

 

[Mad Jack]

Wow, this thread got intense.

This article blasts psychologists by saying they have less training by as little as one year (or up to 2-3), depending on length of program and postdoc. This is splitting hairs and the comparison may not be appropriate due to the different types of training (what if we excluded the years med students are learning general knowledge and doing unrelated rotations and not psychiatric diagnosis/treatment/etc.)?
The author also fails to discuss the nuances of training and education that psychologists receive compared to psychiatrists. She doesn’t have any data to back up her argument, but we’re supposed to accept it because she’s a medical doctor in an unrelated specialty? Hmmm....well, she is inherently superior with those credentials, right?

The reality is, clients lie, and we are expected to take them at their word and respect it. Certainly incompetence or malpractice can be a problem within psychology OR psychiatry practice, but so can overemphasizing responsibility of others involved in a client’s care. In my opinion, our culture is at the extreme of blaming every professional who had contact with the person who died by suicide rather than accepting that, sometimes, people are set on dying, and that’s their free will in action. In some cases, crisis intervention can turn some people’s lives around completely, but sometimes it doesn’t at all (a former client told me that his prior hospitalization was completely unhelpful and also ineffective, unless you consider vowing to kill yourself rather than being hospitalized again as “effective”). I hope our culture can come toward the middle on this issue someday and not externalize the blame in every case. People are complex, as is the issue. This author is taking the easy route by finding a scapegoat that fits her underlying biases.....

While we may train for 8 years to be psychiatrists, only about 12-18 weeks of those first four years are in psychiatric topics. While understanding medicine is very helpful for psychiatry in general (the number of medical illnesses we come across masquerading as psychiatric illnesses that were missed by the medical team in a given month is usually firmly in the double digits), very little of that time will help in any way whatsoever with the assessment of a suicidal patient.

Though I disagree on the taking things at face value bit. If I had a dollar for every time someone told me with a straight face they weren't using and they popped positive for drugs I would be far better off financially, to give but one example.

 

[psyc0100]

I have a family member currently inpatient for 10 days now from SI and SG and no discharge set. It’s totally normal at this very well known and respected hospital. The inpatient doc is < the outpatient doc. Outpatient had to speak to attending several times regarding intern. So, I do think there is huge variability, especially at a teaching hospital.

Yeah this **** is goofy. I have worked at multiple hospitals where the unit psychiatrist basically left a patient on unit an extra week for telling the Dr to go **** themselves or challenging their authority. The fact that some hospitals have a tiny crisis stabilization inpatient unit means nothing to me.

 

[MAClinician]

3) You are aware that UHS remains the subject of a federal investigation regarding their practices of keeping patients longer than would be reasonable, right? Because they just settled for like $120MM with the department of justice for such practices. That might be the “realities of private psychiatric hospitals”. But it doesn’t help your appeal to authority.

Is there an article or summary of the settlement online? UHS has closed a couple of inpatient hospitals in my state and are still operating about 60% of the psychiatric beds in the state unfortunately. I had not heard of this settlement and am interested in reading more if there is anything available.

 

[AbnormalPsych]

Though I disagree on the taking things at face value bit. If I had a dollar for every time someone told me with a straight face they weren't using and they popped positive for drugs I would be far better off financially, to give but one example.

As someone who has and does work in addiction very heavily, clinically and in research, comparing this to suicide assessment is silly and like comparing apples to oranges.

As someone who plans to focus on addiction, most of the patients in my core demographic are liars

I'm sure you are aware, and this is not a dig at you, but this is probably not a great stereotype to enter into patient care with. Stigma in this sub-field you are entering is real and harmful. It deters patients from being open and leads to increase shame and deceit.

 

[PsyDr]

Is there an article or summary of the settlement online? UHS has closed a couple of inpatient hospitals in my state and are still operating about 60% of the psychiatric beds in the state unfortunately. I had not heard of this settlement and am interested in reading more if there is anything available.

UHS agrees to $127M DOJ to settle behavioral health investigation - MedCity News

Alongside the payment, which resolves the civil aspect of the probe from the DOJ and a number of states that UHS incorrectly billed Medicare and Medicaid programs, the government has dropped the criminal investigation against the company.

medcitynews.com

 

[psych.meout]

As someone who has and does work in addiction very heavily, clinically and in research, comparing this to suicide assessment is silly and like comparing apples to oranges.



I'm sure you are aware, and this is not a dig at you, but this is probably not a great stereotype to enter into patient care with. Stigma in this sub-field you are entering is real and harmful. It deters patients from being open and leads to increase shame and deceit.

It's almost like there's some sort of self-fulfilling prophecy when it comes to addiction, deceit, etc.

 

[futureapppsy2]

Is there an article or summary of the settlement online? UHS has closed a couple of inpatient hospitals in my state and are still operating about 60% of the psychiatric beds in the state unfortunately. I had not heard of this settlement and am interested in reading more if there is anything available.

This Buzzfeed investigative report is very thorough and fascinating, in a horrible kind of way. (The ability of Buzzfeed to publish great investigative reporting and also listicles made up of GIFs is an interesting dialectic)

“What The Fuck Just Happened?”

Lock them in. Bill their insurer. Kick them out. How scores of employees and patients say America’s largest psychiatric chain turns patients into profits.

www.buzzfeednews.com

How A 6-Year-Old Got Locked On A Psych Ward

His mother said the boy had merely thrown a tantrum. But a hospital owned by America’s largest psychiatric chain, UHS, held him for three days — and filed a court petition to keep him even longer. While in the hospital, the child suffered a bloody nose and was locked in a seclusion room in the...

www.buzzfeednews.com

Videos Show The Dark Side Of Shadow Mountain Youth Psych Facility

A psychiatric hospital and its director that are under state investigation. Riots that end with pepper spray. Staff who can’t begin to contain the violence. And patients as young as 5. Secret videos show the dark side of Shadow Mountain.

www.buzzfeednews.com

Videos Show UHS Hospital Staff Assaulting Young Patients

It was supposed to be a refuge for troubled adolescents and foster kids who had run out of other options. But at Hill Crest Behavioral Health — part of UHS, America's largest psychiatric hospital chain — a culture of violence flourished. Internal videos show staff members beating and dragging...

www.buzzfeednews.com

How a Giant Psychiatric Hospital Company Tried To Spin Us — And Silence Its Staff

A $100,000 crisis PR plan. An employee fired for supposedly speaking to a reporter. Another employee sued for allegedly leaking internal surveillance videos. Inside the war room of America’s largest psychiatric hospital chain as it responded to our two-year investigation.

www.buzzfeednews.com

 

[Mad Jack]

As someone who has and does work in addiction very heavily, clinically and in research, comparing this to suicide assessment is silly and like comparing apples to oranges.



I'm sure you are aware, and this is not a dig at you, but this is probably not a great stereotype to enter into patient care with. Stigma in this sub-field you are entering is real and harmful. It deters patients from being open and leads to increase shame and deceit.

As I'm sure you are very well aware, addiction changes the priorities of a patient and they engage in behaviors they often wouldn't under normal circumstances. I don't hold it against them that they lie and engage in other behaviors that are spurred on by their addiction. But to deny that certain behaviors exist, such as minimalization of one's drug use or deceit in the pursuit of more substance of abuse, would be nonsensical. I don't judge them for engaging in these behaviors- that's the disease at work- but I am obligated to find the truth so that I can treat a patient properly. I think you are confusing recognizing well-established behaviors of addiction (pursuit of further drug use due to one's addiction, minimization of one's addiction to self/ others, hiding of addiction, etc) with the idea that I have a personal disdain of said behaviors. Objectively, most of the patients I initially evaluate are lying to me to one degree or another. Were I to take their statements at face value rather than collect collateral and labs, I would be doing them a great disservice in their treatment