cads detox in a forensic setting - matua raḵi detox in a forensic... · past history of...
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CADS Detox in a
Forensic Setting:
Match made in heaven?
Zabina Munif
Simmi Singh-Parmar
History
Ward 38 – consists of 2 detox beds, for the Waikato region.
The beds are ‘rented’ by the CADS service
Ward 31
Ward 35
Ward 16
PunaTaunaki
Puawai: Midland Regional
Forensic Psychiatric Service
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.
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
Management of Alcohol Withdrawal:
Alcohol withdrawal is a syndrome of the central nervous system
hyperactivity characterised by symptoms that range from Mild to Severe
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
Progress of Acute Alcohol Withdrawal:
CIWA SCALE
Effective management of
withdrawal in early stages can reduce or prevent progression
into complicated withdrawal
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/ pseudo-seizures, 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.
NURSING PROCESS
Maori Health Model
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 1996. 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.
DAY 1 – 3
Te Whare Tapa Wha
•Sore Neck – C2 #
•Triplopia
•Mobilises with walking stick
•Nil own teeth & partial hearing loss
•Nerve damage
•Alcohol withdrawal symptoms
•Volunteer work
•Suffers from depression since MVA
•Feels ashamed about relapse
•Supportive husband – visited everyday while admitted
FAMILY
HEALTH
MENTAL HEALTH
PHYSICAL HEALTH
SPIRITUAL
HEALTH
Nursing Process
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
•Improved sleep quality
•Symptoms of withdrawals gradually diminishes with each day
•Hopes to re-establish connection with church
•Continue to partake in volunteer work
•Improved mental state
•Future focussed
•Has hope
•Continued support from husband.
FAMILY HEALTH
MENTAL HEALTH
PHYSICAL HEALTH
SPIRITUAL HEALTH
DAY 4 – 7
Te Whare Tapa Wha Nursing Process
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.
Is it a match made in
heaven??
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
Pros Cons
So you can decide….
References:
Alcohol.org.nz
http://www.alcohol.org.nz/help-advice/standard-drinks/tool-a-
guide-to-standard-drinks
Matua Raki (2012). Substance Withdrawal Management-
Guidelines for addiction and allied practitioners.
Wellington:Ministry of Health.