11.2.2  Care of people with emergency mental health conditions

You may be in situations where people will be in need of urgent help but the doctor is too far away or not available. Under these circumstances, you must offer immediate help. In this section we will describe four different situations in which urgent help is needed, and what you should do in these circumstances.

Agitated and violent person

People with agitated and violent behaviour are individuals who are restless, unable to sit still, angry looking and who threaten to attack. Because of the threat of violence this is an emergency situation and you will need to use special techniques to approach them. Box 11.1 explains how you could manage a situation like this.

Box 11.1  How to deal with a violent or agitated person

  • Get help from someone in whom the person has confidence.
  • Advise others not to talk or behave in a way that might irritate or provoke the person.
  • Tell individuals whom the person does not like to keep away.
  • Keep some distance from the person while you try to find out what the reasons are for their anger and what is troubling them.
  • Try to gain the person’s confidence by asking them: ‘What are your problems? Why are you so angry? What is troubling you? I am here to help you.’
  • Do not argue with the person or provoke them.
  • When the person calms down, see that he or she takes some fluids and food.
  • Try to convince them that they need medication and that it is better if they see the doctor.
  • If the person is not in a position to listen to you, organise people to throw a blanket, gabi or netela on the person and hold them with the help of others. Take them to the hospital immediately.
  • Do not use thread, rope or chain to restrain the person. If necessary, use only a towel or long cloth to tie their hands.

Withdrawn person

A withdrawn person is someone who avoids any form of social contact. This may be caused by the presence of suicidal thoughts or plans. Whenever someone threatens to kill themselves, take their words seriously (see Section 10.5 in the previous Study Session). Make sure that there is always someone else present with the person until they are taken to a doctor. Box 11.2 helps you to know what to do when you see a withdrawn person.

Box 11.2  What to do when you see a withdrawn person

  • Take time to talk to the person as they may have a delayed response.
  • Persuade them to eat something.
  • Ask family members for possible reasons for withdrawal.
  • Find out whether they feel like ending their life, and if so, try to find out what the reasons are for the suicidal thoughts.
  • Listen with sympathy, encourage the person to talk about their problems in detail, and reassure them that you will assist them to solve the problems.
  • Take the person to the doctor yourself or refer them immediately, along with a supportive relative or friend.

Paranoid person

You may come across people who have disturbed thoughts. They may be suspicious of other people’s motives, and may think all other people are against them. They may have delusions (as part of psychosis) or the suspiciousness may be due to alcohol abuse or depression. It may not be easy to approach a person in a paranoid state, because they might think you are one of the people who are against them. You must be careful how you go about it; the methods outlined in Box 11.3 may serve as your guidelines.

Box 11.3  What to do when you meet a paranoid person

  • Be fair and honest. Do not tell lies or hide information.
  • Do not question the person’s beliefs or suspicions. Do not tell them that their beliefs are wrong, baseless or false.
  • Allow the person to talk about their suspicions. Collect more information. Do not pass judgement on them.
  • Draw their attention towards their possible other problems, like sleeplessness, decreased appetite, etc. Try to convince the person to see the doctor and to take necessary medication.

Confused person

Persons with extreme confusion may not recognise the time of the day, where they are or where they live, or may not recognise people they have known before. Confusion may be caused by head injury, infectious disease, alcohol withdrawal, or diabetes mellitus, but could also be due to other causes. It is important that you recognise people who are in a confused state, as they need a quick evaluation and urgent referral to a health centre or hospital (see Box 11.4).

Box 11.4  What to do when you see person in a confused state

  • Find out whether the person had jerky movements of the limbs. The confused state could be the consequence of an epileptic fit.
  • Find out whether the person is a known case of diabetes or high blood pressure.
  • Enquire whether the person has had a recent head injury or has consumed alcohol.
  • Tactfully find out whether the person has consumed drugs (perhaps with the intention to commit suicide).
  • Examine the person to see if they have high fever.
  • All people with significant levels of confusion should be referred to a health centre as soon as possible.
  • Because of the risk for an epileptic fit, avoid giving drink or food.
  • Avoid the presence of strangers and unwanted disturbances around the person as it may aggravate the confusion.

11.2.1  Identification of people with mental illness in the community

11.2.3  Referral