Impact of Methamphetamine Intoxication on Restrictive Interventions in Mental Health Inpatient Units

1. Impact of methamphetamine intoxication on the use of restrictive interventions in acute mental health inpatient units Kathleen Kelly, Bec Long, Jess Anderson, Trentham Furness and Brian McKenna Presented by: Kathleen Kelly BN, RN, GradDipMHN Program Manager Sunshine Acute Adult Inpatient Unit Email: kathleen.kelly@mh.org.au Co-presented by: Trentham Furness BHlthSci, BExSci(hons), MExSci, PhD Research Fellow, School of Nursing, Midwifery & Paramedicine Australian Catholic University & NorthWestern Mental Health Email: trentham.furness@mh.org.au

2. Methamphetamine • Methamphetamine (Crystal Meth or ICE)is a growing problem in Australia:- • Large population of dependant meth users • Increases in importation, manufacture and use • Increases in hospitalisations due to substance-induced psychosis • It produces psychiatric symptoms (psychosis, depression and anxiety):- • Many meth users have substance-induced psychotic disorders • Meth use often related to psychiatric ED visits

3. In Emergency Departments • Meth users pose unique challengesto emergency departments:- • 1.2% of all ED attendances at the Royal Perth Hospital • Meth-related ED presentations more commonly related to mental illness • Patients often present with behavioural disturbances e.g. aggression & violence:- • 56% of meth users perceive that their meth use results in violent behaviour

4. In acute in-patient services • In Australia most (84%) consumers with drug induced psychosis are treated in acute in-patient units • Meth-induced psychosis:- • Similar to other psychotic disorders and can be difficult to distinguish • Often require considerable resources because of agitation/aggression • Anecdotal evidence that meth use associated with the use of RI • SAAPU introduced evidence based saliva detection as part of admission • RIs (physical, mechanical and seclusion) are routinely recorded

5. Aim of the Study “To determine the impact of methamphetamine use on the subsequent use of restrictive interventions”

6. Methods Sunshine Acute Adult Psychiatric Unit (SAAPU) at NWMH Retrospective cohort study 3 months data collection December to February 2015 Data collected by registered nurse accessing patient records and documenting on a data collection instrument n=232 consecutive patients admitted to the unit Data entered and analysed in SPSS using descriptive and inferential statistics

7. Substance useDefined by self report and/or +ve on admission POSITIVE ON ADMISSION n=232

8. Substance useDefined by self report and/or +ve on admission SELF REPORTED SUBSTANCE USE n=232

9. Results Profile • Broad range of ages and 52% male • One in four born overseas • Majority (70%) admitted via Emergency Department (ED) • Primary diagnosis: Psychotic illness (39%); Major depressive (13%) • Police involved prior to one in three admissions

10. Results Substance Use • 65% (n=150) substance users including alcohol • Majority (n=139) self reported • Meth, THC and alcohol all used by ≈30% of consumers • Few alcohol only without coincidence of other substances

11. Results RI • RI used in 11% of cases (n=25) • 9% (n=20) physical restraint • 10% (n=23) secluded • Mechanical restraints used in 1 case • 9% (n=22) restrained in ED

12. Variables associated with RIUnivariate analysis

13. Variables associated RIMultivariate analysis

14. Discussion • Meth use is an important predictor of RI • These people are often known (e.g history of RI) • Alerts and flagging are needed • Interventions to manage meth users

15. Reducing use of RI in meth users Aligned with stage of meth abuse cycle • Manage presenting symptoms with appropriate pharmacotherapy:- • agitation/anxiety, seizures, unresponsiveness, renal failure, hyperthermia, dehydration, hypertension, MI, injuries, psychosis. • Keep your distance; • Lower the lights; • Slow your speech, lower your voice; • Slow your movements; • Keep your hands visible; • Keep them talking. • Assess for readiness to change; • Link to drug rehabilitation program. Rush, C., & Walton, S. (2005). Methamphetamine intoxication and related emergency situations. Outlook, 10, 28-21. 21.

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