Psychiatric Social Work Services In Neurology Emergency Care Setting.

Abstract

Background: Psychiatric social workers are important multi-disciplinary team members, and they assess patients and their families social, emotional, environmental, financial, and support needs in emergency settings. They support patients and their families through difficult times and improve patient lives.

Aim: To study the profile of patients availed psychiatric social work services in neurology casualty and emergency settings.

Materials & methods: The study was retrospective in nature. The ex-post facto research design was used in the study. Data were obtained from a casualty & emergency psychiatric social work referral registry maintained by the psychiatric social work team at the Neurology emergency setting at NIMHANS, Bangalore. Patients referred for psychiatric social work interventions from April 2020 to March 2021 were considered for the study purpose. Frequency and percentages were used to describe the data.

Results: Psychiatric social work services at the neurology emergency setting were started in July 2018. Social workers get referrals from triage (four hours to 24 hours), followed by priority ward (72 hours to two weeks), observation ward (72 hours days - two weeks) and emergency ICU. There are 100 beds available for neuro-emergency settings. Of ≈15,939 patients who availed the neurology emergency services, 159 patients were referred for psychiatric social work services. A majority (61.6%) received neuro-education about their illness; awareness about their illness were given to patients and their family members. More than half of them were given guidance for availing treatment welfare benefits under below poverty line and Ayushman Bharath Scheme (54%), 43.3% received supportive psychotherapy, 35.2% pre-discharge counselling, one-third received crisis intervention,12.6% family interventions, 10.7% were facilitated for hospital charges waiver off, few unknown patients management and tracing their family members. Most patients were diagnosed with a stroke, GBS, neuro-infections, and seizure disorder patients who sought psychiatric social work services in emergency and casualty settings. Assessment of their functionality revealed that most were partially independent and dependent. Social workers work from 9 am to 9 pm in the neuro-emergency setting. Immediate social work referrals were made for unknown patients, tracing the caregivers who left the emergency ward without permission, which required financial assistance and communicating poor prognosis (breaking the bad news).

Conclusion: The most common psychiatric social work intervention provided in the neurology emergency care setting were education about the illness, facilitating poor patients to avail social welfare benefits, supportive psychotherapy and crisis intervention.