There will be times when clients affected by AOD problems need to access emergency psychiatric services. There are a number situations that can precipitate this including a relapse from an existing condition or a psychiatric event triggered by current AOD use. It is important that treatment providers are aware of issues that can arise in these circumstances.
The following issues need to be considered when dealing with psychiatric emergencies:
Formal and informal agreements, and communication between different organisations aids in the referral of clients with comorbid AOD and mental health issues. Just as some mental health (MH) workers feel unable to respond to clients with AOD related problems, some AOD staff feel unable to work with MH problems. These barriers can arise because of number of factors, such as:
Given this, taking time to locate the responsive people in the various systems, building relationships with them and developing strategies is likely to be worthwhile.
A Memorandum of Understanding (MOU) is a useful form of agreement between organisations. One effective strategy is to agree to commit a certain amount of worker time to be dedicated to building bridges, whether formal or informal, with local mental health teams and the mental health emergency services. If a MH service is unable to respond because AOD use is involved, always ask them for advice and support over the phone and seek suggestions about where you can refer a client.
Of course, emergency procedures should be used for all emergencies. Some services have enhanced effective responses with police by liaising with them and developing agreed protocols and procedures.
As outlined above, trying to communicate and develop agreements with services to provide shared care is a good way to improve responses to clients experiencing co-existing AOD and mental health problems. However, as the development of these relationships may take some time, there is a need for short-term strategies. A number of strategies have been identified to make the process of crisis referral, particularly to hospitals, easier:
When talking to doctors it helps if you understand medical terminology and can, to a certain extent ‘speak in their language’. It is particularly useful when clinical terminology is being used. However, if you do not understand what is being said, it is advisable to ask for an explanation.
When accompanying a client to the hospital, if possible find out the admitting doctor’s name and phone ahead to inform him/her of your arrival.
Unless it is absolutely necessary, there is no need to overemphasise the fact that your client is an AOD user. If the mental health issue is the primary presenting problem, then ensure that the focus is on that, although do include information about the AOD condition to avoid misdiagnosis.
Be ready to help answer questions about possible involvement of alcohol or other drugs if this seems to be an important part of the presenting problem – especially if it is an emergency where the drug use might be complicating the situation.
For social workers, psychologists and other workers with a professional affiliation, making a professional to professional referral is perhaps the best way to ensure that your client will be seen. For example, if you are a social worker and the situation does not require an emergency response, instead of approaching a medical officer, call the social work department and speak to someone with whom you have a professional allegiance.
If a service is unable to come, or a doctor or a nurse in a hospital is unable to admit a client, ask them for advice. Likewise, always be open to other workers who ask you for advice. This helps to build goodwill within and outside the sector and strong allegiances build better client care. See Information Sheet 7 for advice on building partnerships with other services.
The key to successful liaison and referral is to build good relationships, to understand how the various systems work and to ensure you communicate clearly. Establish and use an agreed problem solving approach when challenges do arise.