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Teaching and learning at New York State psychiatric facilities

Posted Oct 17 2008 9:14pm

I’ve returned from a fascinating series of trips to two New York State psychiatric facilities ( St. Lawrence Psychiatric and Pilgrim Psychiatric ), as part of a project I’m working on with the Office of Mental Health.  I learned a great deal from talking about suicide risk with over 500 clinicians from a variety of disciplines and settings–psychologists, RNs, case managers, social workers, psychiatrists, mobile crisis clinicians, family therapists and others.   It would be hard to find a group of professionals with more experience working with individuals at-risk, and the questions, comments, and concerns the participants contributed matched that level of experience.

I have made some notes about issues that were raised by clinicians, and plan to blog my thoughts about these in coming months as I get pockets of time to reflect on my travels.   As I have stated before, I think it’s important for educational initiatives to map closely onto the real-life concerns of clinicians, rather than simply reflecting content that experts deem important.   Here are a few concerns and questions that I hope to think more about when I have time:/

  • When it comes to hospitalizing isn’t it always best to “err on the side of caution?”
  • Why are we focusing on suicide so much when the people we work with have so many other problems?
  • Why are we focusing on suicide when it’s so rare and most people who die by suicide weren’t in treatment when they die?
  • How do we handle individuals at risk who are only marginally involved in treatment-they miss more appointments than they make, but still come enough that they remain on our caseloads?
  • Does doing a better job with risk for suicide always mean more work and writing?
  • Is there anyone for whom it is not indicated to ask about suicidal thoughts?
  • How often should we do a risk assessment?
  • What kinds of lawsuits have and have not been successful against clinicians in cases of completed suicide?
  • Even if we do everything right, can suicide really be prevented?

Along the lines of that last question, several clinicians shared moving stories about ways in which suicide has touched their lives, personally and professionally.   It is always so sad to hear about these deaths, and so encouraging to hear that some of the ideas I brought for discussion felt relevant to these experiences.

A big thanks to the professionals at OMH, St. Lawrence, and Pilgrim who supported and hosted me during these trips.   And to the clinicians at both facilities who made these trainings so stimulating and enjoyable.

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