MY CAREER AS A PSYCHIATRIC NURSE IN ARIZONA

Alice Parris-Arizona State Hospital

Alice Parris-Arizona State Hospital

I spent sixteen years of my twenty-five year nursing career as a Psychiatric
Nurse. In Arizona, they call it Behavioral Health. I worked in private facilities
for adolescents, where they had a private chef, to registry work with adults-
also in private Behavioral Health facilities, to the Arizona State Hospital where
I worked on all of its Forensic Units. I spent more time in Geriatric Forensic and
Adolescent Forensic than I spent with adults. Any call-offs by scheduled Registered
Nurses could mean that any nurse could be floated to any unit at anytime.

When I first went to the State Hospital, as a registry nurse, I admit that I
was terrified by the looks in the eyes of the patients. We would describe it
as “looking off.” I spent my first day grateful to be in the medication room
preparing medications and not on the floor being terrified. Patients would cue
up to receive scheduled medications at a door at the med room which had a top
that could open, while the bottom of the door was locked. This was to prevent the
possibility of a newly admitted patient from charging at the medication nurse.
A staff member stood beside the patient to help identify them, many or most had
removed their admission wrist bands.

I cannot describe the first few minutes of that first day, starting with the
sound of doors being locked behind me. Fear welled up inside of me. By the end
of the first day, I had been chased around the unit by a new patient (who had
been in and out of physical restraints all day.) New patients were not stabilized
on their medications and staff did not know their “cuing behaviors.” Cuing behaviors
are predictable movements within certain patients that would proceed an attack on
other patients or staff member-such as pacing, increased verbal assaults, facial
expressions. As a medication nurse, the faster a nurse could draw up IM medications,
the safer the staff would be. Staff would dislike a “slow nurse” who put them at risk.

Chaos could break out at any time, over anything. When one patient “blew” it was
like the popping of popcorn; others would follow suit. Soon a “riot” would have
broken out on a unit. One of the jobs of the floor staff was to monitor for cuing
behavior and when observed, notify the charge nurse or med nurse so an oral liquid
form of the medication could be offered to the patient. If the patient refused, it
would more than likely lead to a “show-down” and sadly, physicians orders for a
Seclusion and Restraint would be issued for the patient, so that they could receive
their medications IM. Seclusions and Restraints follow strict safety guidelines for
the patients: continuous monitoring of vital signs, bathroom needs and a re-assessment
for compliance every two hours. Remember at a state facility, if compliant per
verbal agreement, the patients were allowed back into the general population. Many
of these patients had already had a brush with the law or community and were determined
to be a danger to themselves or to others. Some were petitioned and some were court
ordered until “competency” could be established (if facing legal charges.) Some patients
could not understand the charges against them and had to be prepared to go before a judge
by virtue of role-play undertaken by professionals.

Malingerers, who had broken the law, but were there to avoid “real jail” were easily
weeded out by behaviors. Occassionally, a patient had become so “institutionalized,”
that they were terrified of leaving a “step-down” unit and going into a monitored
living environment outside of the high metal fences and barbed wire. Such a patient
could easily try to “cheek” their medication as to allow the fullness of their mental
illness to resurface. By “cheeking” I mean not swallowing their medication-hiding them
in the mouth, until they could “stock-pile” it.( which in itself is dangerous should
the patient decide to try an attempt at suicide.) Not taking medication would lead to
the de-stabilization of the patient. Erratic behavior and violence were not far behind.
There was a protocol to ensure that patients could not “cheek” their meds. Every now and
again, a patient would “outfox” the staff, anyway. Every shift that a mental health
professional stepped onto the floor of a Forensic Unit was an act of courage and bravery.

It is needful to make a distinction between “non seriously mentally ill” and “seriously
mentally ill.” Also, to make a distinction between someone with suicidal ideation versus
homicidal ideation. “Non seriously mentally ill” could be cyclothymic, bipolar along with
personality disorders. Also, poor impulse control, poor insight in various combinations.
Seriously mentally ill, could cover the gamut: sociopaths (antisocial personality disorders)
with homicidal ideation, Paranoid Schizophrenia; a combination of diagnosises rendering them
incapable of holding down a job. I believe that many homeless in Arizona are mentally
ill. They fell through the “criteria-cracks.” They were too ill to get out of the relentless sun in the summer where dozens yearly would die from heat stroke. The summer before I left Arizona, the good citizens went around to the homeless passing out bottles of water. I often wondered why emergency lodging was not provided for these people, for the water would run out. They looked too shabby or scary to hang out in the air-conditioned mall. They would more than likely be chased away by mall security for frightening the shoppers and ruining their spending day.

While the conversation ensues about guns and the mentally ill, it is my belief that people who display poor impulse control, who hate & fear are just as dangerous as the seriously mentally ill, in a “perfect storm. It is my concern that people who are not knowledgeable about the differing degrees of mental illness do not put everybody into one lump. There are “Patient’s Rights” to consider. The mentally ill have these rights, as well they should. In Arizona, there is petitioning process available. I suspect that those who observed Jared’s behavior were afraid of him. They would be afraid to petition him, even his parents were probably justifiably afraid of him. They would not want the repercussions of having petitioned him not knowing what he might do when he came out. Most of the community probably recognized the possibility that he had “homicidal ideation.” Police can be called in to pick up and take to an assessment facility those who need mental health services but are not willing to seek them on their own.The criteria in Arizona is “danger to self or danger to others.” Someone could have called the police anonymously to ask them to monitor a person behaving strangely within their neighborhood or community.

It is my hope that this blog will help America not to further stigmatize people who have already been stigmatized. Americans always seem to need a new underdog to kick-about. I hear the words, “nuts” and “crazies” bandied about. It is NOT OKAY! Rather use the terms “disturbed” or “seriously mentally ill.” Talk about “suicidal or homocidal ideation.” I pray that the people who are seeking a solution, find an effective, compassionate way to deal with mental illness as it relates to gun ownership. We do not need any more cruelty in our minds or our conversations. We do not need those in need of our help to
be hiding fearfully in the shadows. We do not need the seriously mentally ill to feel paranoid about being discussed in a perceived “threatening” way. This might prove counterproductive. All of the seriously mentally ill are not in “the system.” Our civility in this specific matter, itself, could save lives.

Alice Parris

REALITY CHECKS FOR REALITY TELEVISION

After spending the past year with my twenty-seven year old daughter and her friends, I have been shown where to find the  most hilarious moments on cable. By far, Reality Television rates at the top of the dysfunction food-chain and is by definition a panacea for the chronically bored to death.  I have noticed a recurrent pattern with the numerous shows that I have watched. I can see what makes for “great” reality moments and what makes a show less than exciting.

It comes down to having a good mix of mental illnesses and personality disorders within the pool of contestants. This will always produce the unexpected at any time. Take two or three bipolars with various degrees of mood swings; not swinging at the same time. Add contestants with ADD, ADHD( poor impulse control), borderline personalities, narcissists, fragile personalities and strong antisocial personalities, then you are going to have fireworks! If you look at the dysfunction of one of the most highly watched shows, “I love New York,” you will find your dysfunction primarily in the personality of the  “prize.”  You add a controlling mother, who could possibly be any combination of the mental/personality disorders,  then, you won’t need as many competitors who randomly “act out” in order to have the consistant weekly level of drama required for addictive-watching by millions.

Have you noticed the many random melt-downs? Have you noticed the defined arch-enemies?  Have you noticed the chief manipulators and their crews? Have you noticed how many times “friends” have been “thrown under the bus” in the name of competition? If it were a psychiatric ward,  not a televised competition, then there would be consequences for not only acts of violence, but for a myriad of manipulations that are associated with these disorders. What the television industry has done is to successfully put “mental patients” together in a fishbowl (in the name of competition) and let them all “do their thing.” This is proving to be a very lucrative venture.

What you do not see are the consequences of rejection that create a “downward spiral” in the personalities that really do want love or the “prize”, once they are bounced from the program. There should be on-staff clinical psychologists to assess people who are painfully expelled at the notorious “expulsion ceremonies.”  Who follows these people to make sure that they don’t fall into a depression that could result in “suicidal ideation” being acted upon? Who is to keep the promiscuous bipolar, who has a history of early sexual abuse, from engaging in even more dangerous sexual behaviors once expelled? Who is going to follow-up on the young man who hates his mother and has been publically rejected,  perhaps ridiculed by a “female figure” from beginning a life of psychopathic violence towards women? Who will watch out for a fledgeling “black-widow” in the making?

One thing can be said. If the producers of these shows did some digging into the pasts of the contestants, there would be no shows at all. There would always be red flags. There would be liability as prevelant as the drama.  Most of the young people on the reality shows have not yet been diagnosed. They are self-medicated by booze while on set, and may be on drugs when living their regular lives.  Just think about the tragic outcome of,  “Megan Wants A Millionaire.” The young man to whom Megan was most physically attracted was the suspect of a “manhunt” for the alleged mutilation/murder of his wife. This story ended up in Canada, where the millionaire contestant committed suicide. If any of these contestants had been given a personality profile, there might  have been a red flag by the deceased contestant’s name. What would have happened if Megan fell in love with this man and they spent a great deal of time together after filming? What if she began to exhibit the same type of behaviors that could have driven him to  alleged heinous behavior? What would be the liability for the creators/producers of this reality show? It has been pulled from television, now, due to the high profile nature of this case. Only those who filmed the show (and their intimates) know who Megan chose to be “her millionaire.” A reunion show? Not a chance!

 It is not enough to ask someone in their twenties if they have ever had a felony. It is not enough to have a urine-test for substances. It is not enough to ask someone if they have ever had homocidal or suicidal thoughts. They will lie, take herb/cleaners for urine drug screens, and present well. What contestant who wants love or money is going to admit to hearing voices, or having homicidal/ suicidal thoughts? What will be the scrutiny from now on upon these reckless forays into the “crazy-making” fishbowls known as “Reality Television?”  Somewhere quality risk management needs to be implemented immediately; not to rob the show of its excitement but to protect the contestants from themselves and others during and after the tapings.

Alice Parris