Psychiatry Emergency patient

1. What constitutes a Psychiatric Emergency?

An individual experiencing any signs of mental illness resulting in an ongoing current risk or imminent future risk to self or others constitutes a Psychiatric Emergency and would be seen and evaluated EPAC service at the NIMHANS Emergency Psychiatry Ward (Psychiatry Short Stay Ward).

Signs that a person may be suffering from a Mental Illness are any change in a person’s thinking, behavior, mood and/or sensory experiences associated with a disturbance of the person’s personal, social and/or occupational functioning resulting in an inability to carry out their day to day roles and responsibilities.

Some examples of a Psychiatric Emergency include but are not limited to

• Individuals expressing Suicidal thoughts or recently having made a suicidal attempt
• Individuals expressing thoughts of harming others or recently harmed others in the presence of other signs of Mental Illness
• Severe and persistent Agitation or aggression due to mental Illness
• Severe neglect of self-care due to mental Illness
• Maintaining a posture for prolonged periods associated with not talking/expressing needs

2. How do I reach NIMHANS?

If you or a person known to you is experiencing a Psychiatric Emergency, you can reach NIMHANS using the following

• Free day time ambulance services for psychiatric patients in Bangalore: 9449000739.
• For Karnataka residents, contact numbers: 9980036174/ 9845260744 (In Bangalore)
• State Ambulance Service (Ph: +91-80-108): within and Outside Bangalore
• Any other Ambulance service (+91-80-102)
• Personal Transport
• Contacting the Police and using their assistance (Ph: +91-80-100)
• For information on ambulance services in other states, contact disability commissioner’s office.

3. Who will I meet when I bring the patient to emergency department?

When you wish to avail the emergency psychiatry service at NIMHANS, you will be first seen by a Casualty Medical Officer (CMO), who will assess the nature of complaints and then refer you appropriately either to the neurologist / neurosurgeon / psychiatrist. This is because, sometimes, signs of mental illness may be caused by Neurological and Neurosurgical conditions as well as other Medical conditions. The treatment for these conditions may also resolve the signs of mental illness.

If the CMO refers you to Emergency Psychiatry Ward (Psychiatry Short Stay Ward-SSW) you will be seen by the Resident Psychiatry Duty Doctor. The Doctor would evaluate the nature of the problems; help with immediately containing the situation if there is any imminent risk to anyone’s safety and the patient will be admitted if required to the SSW. Appropriate investigations will be done and further observations of the patient would be conducted. Even if there is obvious psychiatric symptoms with distress, the patient will still have a medical evaluation concurrently with the psychiatric evaluation. This is to rule out any medical conditions that could be confused with a psychiatric condition. In case signs of mental illness are deemed to be due to a medical problem pertaining to any other system in the body and are non-neurological, then you will be referred to any general hospital to ensure that you receive appropriate medical treatment. If signs of mental illness are due to a Neurological/Neurosurgical cause then you would be referred to the appropriate department at NIMHANS.

4. How long will it take to see the psychiatrist in the emergency department?

On your arrival to the SSW you will be attended to by a member of the Emergency Psychiatry Duty Team within 10-15 minutes. An initial Triage would be conducted. Triage helps determine the seriousness of the problem and prioritize care when multiple patients requiring evaluation at the same time are in the Emergency SSW. It helps the Psychiatric evaluation if ALL information related to the condition including any prior treatment received is provided (please bring documentation of the same if available). You will have to register and provide contact details to receive treatment at NIMHANS. A file will be opened and all details of the visit will be documented so as to ensure continuity of care is maintained.

5. What is the process of Evaluation and Treatment in the Psychiatry Emergency Ward?

Based on the Triage a subsequent clinical assessment will be conducted. Related investigations and a period of ongoing clinical observation in the Psychiatry SSW will further assist in the psychiatric evaluation. Investigations may include Blood and urine tests and possibly a CT scan Brain where needed. There consequently is a variable period of waiting time during which you will be required to stay in the Psychiatry SSW. The outcome of the above would be discussed with you and a further treatment plan formulated in conjunction with you. This could be either further treatment in the hospital setting as an in-patient or you may be advised to go home and continue treatment on an Out-patient basis. If you are advised Out-patient treatment the date and time for the next consultation will be provided.

6. I am an earlier patient of Psychiatry at NIMHANS; in what situations should I come to Emergency (Casualty) instead of the scheduled appointment at follow up Out-Patient Department?

If you are an existing patient of Psychiatry at NIMHANS, you can attend the Out-patient service if the below mentioned situations arise. The Out-patient service is available from Monday to Saturday, 9:00 am to 2:00 pm. After these hours you would be required to attend the NIMHANS Casualty in case the following are observed by you

• A sudden worsening of illness resulting in risk to others or self
• Sudden Development of new signs not seen earlier when ill
• Tremulousness, Rigidity of hands, legs or neck after initiating treatment or change in medication dose
• Patients expressing thoughts of harm to self or others in any context or demonstrating the same

7. Can I meet my earlier treating doctor if I come to Casualty?

You will be seen initially by the Emergency Psychiatry Duty Team. Following a clinical assessment, investigations and a period of ongoing clinical observation if a decision to admit the patient is made, further care would be provided under the Consultant Doctor’s Unit who has treated you previously. Doctors who provide care to the patients in the Psychiatry Short Stay Ward (SSW) and comprise the Duty Team include Resident doctors who will carry out the initial Clinical Assessment and appropriate investigations; the Senior Resident who will supervise all the evaluation and plan further management on site and an on-call Consultant. The residents will not be permanent in any Psychiatry Unit and rotate periodically; hence different Resident doctors may provide care on different occasions

8. I am not sure if it is an emergency, what do I do?

Please consult the nearest Doctor or Health Centre/Hospital and provide them all the information regarding the nature of your problems (if you are a registered patient at NIMHANS, please provide details of prior treatment received at NIMHANS). They would assist you in determining the nature of the problem and advise accordingly. If you do not have the symptoms as mentioned above then you can come and meet a doctor from your treating team on a Follow up day even without prior appointment or alternatively any Out-patient Service day of the week, Monday to Saturday.

9. Will I be admitted or referred to another hospital?

You will be assessed by the Emergency Psychiatry Duty Team and based on the outcome of the same; you will be either provided further treatment at NIMHANS as an in-patient or Out-patient or referred to a General hospital/Department. In the Psychiatry SSW, the time taken to determine further treatment is on an average 5-6 hours, the maximum being 24 hours.

10. Is there a way I can phone a doctor in an emergency?

Psychiatric Emergencies may have different causes such as medical conditions and Neurological conditions even if you have been suffering from a mental illness previously. As a result a phone consultation may not be providing an appropriate medium for a doctor to identify the exact cause of the same. NIMHANS does not provide Phone based Emergency Psychiatry services.

Please consult the nearest Doctor or Health Centre/Hospital and provide them all the information regarding the nature of your problems/ prior treatment received at NIMHANS. They would assist you in determining the nature of the problems and facilitating your referral to NIMHANS.