Guidebook for Psychiatric Emergencies

The following are the symptoms of a psychiatric emergency:

• Signs of attempted suicide, or suicidal thoughts (talking of death, saying farewell, depression, etc.);

• The risk of committing acts of violence (physical, sexual) towards others;

• Exposure to violence or threat of violence (physical, sexual);

• Strange / unusual behavior (talking to visions or disembodied voices, cutting off all communication and interaction with others, etc.).

Steps to take in case of a psychiatric emergency:

• The symptoms listed above may require immediate emergency action.  Evaluation of the situation, initial intervention, and referral to a hospital if necessary are the responsibility of the Health Center Psychiatrist. 

• In psychiatric emergencies, ensuring the safety of the patient and those in the vicinity is of utmost importance.

• Any emergency action must be taken with respect to the person and his/her personal rights.

• Confidentiality of private life must be observed.  Information about the emergency can be shared only with people who have the authority and responsibility to intervene.

• A psychiatric emergency can occur anywhere on campus, at any time.  Every person who has witnessed the situation is responsible for providing support (calming the person, convincing him/her to get help, staying with the person during the intervention and the person’s transfer to authorized persons or units).

• The person who has witnessed the situation must transfer this responsibility to authorized persons as soon as possible.

• If the person is cooperating, he/she can be directed to the Health Center, and escorted if necessary.

• If the person resists or totally refuses help, escort by security unit personnel is required.  The responsibility to help the person cannot be transferred to anyone other than the person’s family members and the hospital the patient is taken to.

• If the person is a student, the responsibility to accompany him/her cannot be transferred to his/her roommates or class mates, even if they volunteer to do so.

Health Center

When informed of a psychiatric emergency, the head nurse or the nurse on duty takes the following steps, representing the center:

i. Contacts the psychiatrist (or the responsible physician in his absence), explains the situation, conducts the initial emergency action in line with their directives,

ii. In line with the psychiatrist’s (or the responsible physician’s) directives, informs the patient’s family or an adult named by the patient and asks them to escort the patient for support, 

iii. If the person involved in psychiatric emergency is a student staying in one of the dorms, and if the nurse in charge believes it will help the patient or those with him, he/she may inform the manager of the relevant dorm and the student’s academic advisor, without violating the privacy of information,

iv. If the situation requiring emergency action is beyond the capabilities of the Health Center, the person on duty calls the nearest hospital that has a psychiatric department and makes the initial arrangements for the patient’s commitment.

If, for any reason, the Health Center cannot be accessed, or if help from the Health Center is refused, the emergency line of the University 1100 is called and the directives of the responding personnel are followed.  Other help lines that can be called are Emergency Help Line 112 and Medline 444 1212  – a private health service company with which the university has signed an agreement.

Security

Other than the Health Center, the security personnel on night shift are responsible for intervening in a psychiatric emergency situation.  The security officer escorts the patient to the Health Center, or to the hospital when necessary.  If the person resists help and being escorted by the security officer but does not constitute a risk, the security officer may contact the relevant unit and call the patient’s family (or the adult the patient names), asks them to come; he/she stays with the person until they arrive.  If the case involves both resistance and risk, the security officer transfers the person to authorized persons, by convincing him/her or using the least possible physical intervention.  The security officer reports the developments to his supervisor and to the Health Center.  Escort duty may last up to an hour, depending on the traffic and conditions at the hospital.  The accompanying officer is then taken back to the campus by University means.

BUREM/BUSOD

Students Service Units are not responsible for emergency action or polyclinic services; however, if the patient has voiced a preference as to receiving help from those units or accepts only their help and refuses others, these units can provide support to the patient and the persons in the vicinity who have been affected by the situation, help the process, and convince the patient accept psychiatric help.  The Units ensure that the psychiatrist is informed about the situation and that he provides the necessary supervision.

When you are with a person suffering from a psychiatric emergency,

√ Make sure that you and the other person/persons are safe, or call security for help.
× Do not assume all responsibility and try to be the hero.

√ Remain calm or request help from someone who can stay calm.
× Do not panic

√ Take the situation and the person seriously.
× Do not brush aside or judge the situation or the person.

√ Listen to the person if he/she is talking.
×  Do not get into an argument with the person, do not go further into the issue, refrain from analyzing or diagnosing the situation.

√ Tell the person briefly what you will do to help.
× Do not make promises you cannot keep.

• An acute psychological emergency bears the risk of the individual harming himself/herself or those in the vicinity.

• The person indicating signs of psychiatric disturbance must be referred to the Health Center (ext. 1100), the unit which has the responsibility of interfering in an emergency. 

• Escort by an officer from the Security Office (ext. 1100) must be ensured.

• The responsibility to support and escort the person belongs to the family or personnel, and cannot be transferred to students.

• If the person suffering from a psychiatric disturbance is a student, The Office of the Dean of Student Affairs is informed; if the person is a university staff member, the Office of the Secretary General must be informed.

• The responsibility to inform family or dorm manager belongs to the specialist working with the student.

• Any emergency action or interference is conducted in line with principles of safety, benefit, and respect regarding the patient and those around him, and confidentiality of
private life.