CADS Detox in a Forensic Setting:

Transcription

1 CADS Detox in a Forensic Setting: Match made in heaven? Zabina Munif Simmi Singh-Parmar

2 History Ward 38 consists of 2 detox beds, for the Waikato region. The beds are rented by the CADS service Puawai: Midland Regional Forensic Psychiatric Service Ward 16 Puna Taunaki Ward 35 Ward 31

3 15 beds (9 minimum secure, 4 rehabilitation extended care (high and complex needs) and 2 Alcohol and Drug Stabilisation beds) is an open rehabilitation unit located in the HRBC. Low risk to self and others Stable in mental state, not overtly psychopathology. Our goal is to successfully treat the person s illness and eventually safely rehabilitate them back into their home/ community, as seamlessly as possible.

4 Ward 38 CADS receives referrals from example: GP, consult liaison, self referrals, Family, NGO s MDT plan and book the admissions as part of the wider treatment plan 7 day informal admission Alcohol withdrawal and stabilisation Withdrawal from Opioids usually transfer from Methadone to Suboxone. Discharge plan: will usually be proceeded to treatment with a residential provider Social detox Extensive Rehabilitation Programme

5 Management of Alcohol Withdrawal: Alcohol withdrawal is a syndrome of the central nervous system hyperactivity characterised by symptoms that range from Mild to Severe

6 Admission to Hospital Criteria for Alcohol Withdrawal : >15 standard drinks/day Past history of complicated withdrawal and/or Serious physical or mental health problems and/or complication factors: Co-existing physical health problems Co-existing mental health problems Other substance use History or high risk of seizures Risk complications, i.e. dehydration or electrolyte imbalance

7 Progress of Acute Alcohol Withdrawal:

8 CIWA SCALE Effective management of withdrawal in early stages can reduce or prevent progression into complicated withdrawal

9 In Summary The most critical period within the detox phase is usually the first 3 4 days due to the neurological hypersensitivity associated with this process: service users often experience sensitivity to noise, light, nausea/vomiting and seizures. Some of the more recent complex cases, have been related to full tonic-colonic seizure/ pseudoseizures, complex conditions related to heart failure, mobility issues, renal failure, communicable diseases, unstable diabetes, psychiatric disorders often with complex trauma history and impulsive behaviours, which has affected their treatment.

10 Maori Health Model NURSING PROCESS

11 Case Presentation Mrs H Mrs H is a 59 year old who self referred to the services. Used 2 3 bottles of white wine (14 21 standard drinks) daily. Able to remain abstinent for 2 years, before relapsing 8 months prior to seeking treatment. Feels ashamed about relapse and doesn t wish to reveal the relapse to family. Lives with supportive husband. Was in an MVA in Suffered internal injuries, nerve damage. Head injury, C2 #, compound right arm # and back-pelvis # Partial hearing loss and full dental extraction (uses dentures). Uses walking stick to mobilise Now works as a volunteer at a local stroke club.

12 DAY 1 3 Te Whare Tapa Wha Nursing Process Supportive husband visited everyday while admitted Volunteer work FAMILY SPIRITUAL MENTAL PHYSICAL Suffers from depression since MVA Feels ashamed about relapse Sore Neck C2 # Triplopia Mobilises with walking stick Nil own teeth & partial hearing loss Nerve damage Alcohol withdrawal symptoms Family Health Sought consent from Mrs H about sharing treatment details with husband. Invited husband to attend reviews with wife and the CADS team. Mental Health Administer anti-depressive medication Positive feedback about seeking treatment. Mental state monitored on every shift Physical Health House officer informed of admission medical physical completed. ECG and admission bloods Reducing diazepam regime, IMI Thiamine, Multivitamin commenced along with other medication taken daily in community. Referral to physiotherapist Kitchen informed of dietary requirement Encouraged to use glasses and hearing aids. Staff checked water temperature prior to showers. Spiritual Health Staff supportive of Mrs H s wish to continue volunteer work after discharge

13 DAY 4 7 Te Whare Tapa Wha Nursing Process Continued support from husband. Hopes to reestablish connection with church Continue to partake in volunteer work FAMILY SPIRITUAL MENTAL PHYSICAL Improved mental state Future focussed Has hope Improved sleep quality Symptoms of withdrawals gradually diminishes with each day Family Health Staff continued to appropriately inform/update Mrs H s husband of treatment progress. May go out on escorted 2-3 hour leave with family. Mental Health Continue to monitor mental state on every shift Improvement in mood, self-esteem noted. Continue to administer anti-depressive medication. Encouraged to identify triggers that may lead to relapse. Encouraged to identify distractions or coping mechanisms. Physical Health Continue with reducing diazepam regime. Commence oral Thiamine. Can utilise short grounds leave. Encouraged to use glasses and hearing aids. Spiritual Health Staff supportive of Mrs H s wish to continue volunteer work after discharge Escorted to attend church service on hospital grounds.

14 Is it a match made in heaven?? Pros Cons We cater to mental health as well as physical health. Service users report feeling less judged and more supported Able to quickly respond to medical issues, as we are located in the hospital. Have the resources to manage these areas of increased risk The philosophy of our units recovery/ rehabilitation focused Service users report feeling less stressed and anxious about admission, due to the warm/ homely environment. Can have unescorted leave off the unit once stabilised However others feel that they do not need to be treated within a mental health facility and fear that they have been labelled with a psychiatric disorder The stigma related to psychiatric disorders & forensic service users Frustrated with restrictions particularly in the first 72hrs So you can decide.

15 References: Alcohol.org.nz Matua Raki (2012). Substance Withdrawal Management- Guidelines for addiction and allied practitioners. Wellington:Ministry of Health.