CADS Detox in a

Forensic Setting:

Match made in heaven?

Zabina Munif

Simmi Singh-Parmar

History

Ward 38 – consists of 2 detox beds, for the Waikato region.

The beds are ‘rented’ by the CADS service

Ward 31

Ward 35

Ward 16

PunaTaunaki

Puawai: Midland Regional

Forensic Psychiatric Service

15 beds (9 minimum secure, 4 rehabilitation extended care (high and complex needs) and 2 Alcohol and Drug Stabilisation beds)

is an open rehabilitation unit located in the HRBC. Low risk to self and others

Stable in mental state, not overtly psychopathology.

Our goal is to successfully treat the person’s illness and eventually safely rehabilitate them back into their home/ community, as seamlessly as possible.

Ward 38

CADS receives referrals from example: GP, consult liaison, self referrals, Family, NGO’s

MDT plan and book the admissions as part of the wider treatment plan

7 day informal admission

Alcohol withdrawal and stabilisation

Withdrawal from Opioids – usually transfer from Methadone to Suboxone.

Discharge plan: will usually be proceeded to treatment with a residential provider

Social detox

Extensive Rehabilitation Programme

Management of Alcohol Withdrawal:

Alcohol withdrawal is a syndrome of the central nervous system

hyperactivity characterised by symptoms that range from Mild to Severe

Admission to Hospital Criteria for Alcohol

Withdrawal :

>15 standard drinks/day

Past history of complicated withdrawal and/or

Serious physical or mental health problems and/or complication factors: Co-existing physical health problems

Co-existing mental health problems

Other substance use

History or high risk of seizures

Risk complications, i.e. dehydration or electrolyte imbalance

Progress of Acute Alcohol Withdrawal:

CIWA SCALE

Effective management of

withdrawal in early stages can reduce or prevent progression

into complicated withdrawal

In Summary… The most critical period within the detox phase

is usually the first 3 – 4 days – due to the neurological hypersensitivity associated with this process: service users often experience sensitivity to noise,

light, nausea/vomiting and seizures.

Some of the more recent complex cases, have been related to full tonic-colonic seizure/ pseudo-seizures, complex conditions related to heart failure, mobility issues, renal failure, communicable diseases, unstable diabetes, psychiatric disorders often with complex trauma history and impulsive behaviours, which has affected their treatment.

NURSING PROCESS

Maori Health Model

Case Presentation – Mrs H

Mrs H is a 59 year old who self referred to the services.

Used 2 – 3 bottles of white wine (14 – 21 standard drinks) daily.

Able to remain abstinent for 2 years, before relapsing 8 months prior to seeking treatment.

Feels ashamed about relapse and doesn’t wish to reveal the relapse to family.

Lives with supportive husband.

Was in an MVA in 1996. Suffered internal injuries, nerve damage. Head injury, C2 #, compound right arm # and back-pelvis # Partial hearing loss and full dental extraction (uses

dentures). Uses walking stick to mobilise

Now works as a volunteer at a local stroke club.

DAY 1 – 3

Te Whare Tapa Wha

•Sore Neck – C2 #

•Triplopia

•Mobilises with walking stick

•Nil own teeth & partial hearing loss

•Nerve damage

•Alcohol withdrawal symptoms

•Volunteer work

•Suffers from depression since MVA

•Feels ashamed about relapse

•Supportive husband – visited everyday while admitted

FAMILY

HEALTH

MENTAL HEALTH

PHYSICAL HEALTH

SPIRITUAL

HEALTH

Nursing Process

Family Health Sought consent from Mrs H about sharing

treatment details with husband.

Invited husband to attend reviews with wife and the CADS team.

Mental Health Administer anti-depressive medication

Positive feedback about seeking treatment.

Mental state monitored on every shift

Physical Health House officer informed of admission –medical

physical completed.

ECG and admission bloods

Reducing diazepam regime, IMI Thiamine, Multivitamin commenced along with other medication taken daily in community.

Referral to physiotherapist

Kitchen informed of dietary requirement

Encouraged to use glasses and hearing aids.

Staff checked water temperature prior to showers.

Spiritual Health Staff supportive of Mrs H’s wish to continue

volunteer work after discharge

•Improved sleep quality

•Symptoms of withdrawals gradually diminishes with each day

•Hopes to re-establish connection with church

•Continue to partake in volunteer work

•Improved mental state

•Future focussed

•Has hope

•Continued support from husband.

FAMILY HEALTH

MENTAL HEALTH

PHYSICAL HEALTH

SPIRITUAL HEALTH

DAY 4 – 7

Te Whare Tapa Wha Nursing Process

Family Health Staff continued to appropriately inform/update

Mrs H’s husband of treatment progress.

May go out on escorted 2 - 3 hour leave with family.

Mental Health Continue to monitor mental state on every shift

Improvement in mood, self-esteem noted.

Continue to administer anti-depressive medication.

Encouraged to identify triggers that may lead to relapse.

Encouraged to identify distractions or coping mechanisms.

Physical Health Continue with reducing diazepam regime.

Commence oral Thiamine.

Can utilise short grounds leave.

Encouraged to use glasses and hearing aids.

Spiritual Health Staff supportive of Mrs H’s wish to continue

volunteer work after discharge

Escorted to attend church service on hospital grounds.

Is it a match made in

heaven??

We cater to mental health as well as physical health. Service users report feeling less

judged and more supported Able to quickly respond to medical

issues, as we are located in the hospital.

Have the resources to manage these areas of increased risk

The philosophy of our units –recovery/ rehabilitation focused Service users report feeling less

stressed and anxious about admission, due to the warm/ homely environment.

Can have unescorted leave off the unit once stabilised

However others feel that they do not need to be treated within a mental health facility and fear that they have been labelled with a psychiatric disorder

The stigma related to psychiatric disorders & forensic service users

Frustrated with restrictions –particularly in the first 72hrs

Pros Cons

So you can decide….

References:

Alcohol.org.nz

http://www.alcohol.org.nz/help-advice/standard-drinks/tool-a-

guide-to-standard-drinks

Matua Raki (2012). Substance Withdrawal Management-

Guidelines for addiction and allied practitioners.

Wellington:Ministry of Health.