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The nurses have to deal with some of it, since they’re the front-line people who have to forcibly inject patients with medication, and they have gotten burned a couple of times.And we doctors are certainly trained to assess for it, defuse it, and if worst comes to worst hold our own until someone can get help.People get a chance to cool off and forget about whatever set them off. If they’re lucky, our social workers have managed to connect them to a better outpatient psychiatrist, care home, or support group, and maybe that will improve their lives sometime down the line.But I don’t think anyone imagines there was some fundamental Quality Of Dangerousness in them which is now gone.There is no way we could leave this equilibrium now even if we wanted to, because if we didn’t keep these people for a week and they ever attempted suicide again, we would get sued to oblivion. On the other hand, there’s lots of structure – art therapy at 10, meeting with your doctor at 11, recreation group at 12, and so on.The third most common type of case I see is “severely mentally ill person who’s been living at a care home for twenty years, but then they got in a fight and so their care home sent them to the hospital.” We shuffle their medications around and send them back to the care home where they’d been living happily for twenty years until some random trigger set them off. It’s like a terrible vacation in the world’s least attractive hotel.With very few exceptions, there is nobody so mentally ill that calmness authority the implied threat of burly security guards won’t get them to grumble under their breath but generally comply with your requests, reasonable or otherwise. I’d like to say I’ve taken advantage of this to go mad with power.But it’s actually a really crappy situation for everyone involved.
In fact, psych hospitals are much more orderly than you would think.
The only people you really have to worry about most of the time are the manic ones and occasionally severe autistics, and even they’re usually okay.