A patient with severe mental illness who lives independently in an apartment and attends a psychosocial rehabilitation program 4 days a week presents at the emergency department seeking admission to the inpatient psychiatric unit. The mental status examination reveals no acute symptoms of psychiatric disorder. Her chief complaint is that she has no money to pay her rent or refill her antipsychotic medication prescription. The best action for the emergency department nurse would be to:

Question

a. arrange for a short in-patient admission and begin discharge planning.
b. send the patient to a homeless shelter until housing can be arranged.
c. involve the patient's case manager to provide crisis intervention.
d. explain that one must have more psychiatric symptoms to be admitted.

Answer 1

C
Impaired stress tolerance and problem-solving abilities can cause persons with SMI to experience relatively minor stressors as crises. This patient has run out of money, and this has overwhelmed her ability to cope, resulting in a crisis for which crisis intervention would be an appropriate response. Inpatient care is not clinically indicated, nor is the patient homeless (although she may fear she is). Telling the patient that she is not symptomatic enough to be admitted may prompt malingering.