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 the outcome of 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. For the study purpose, neurological patients referred for psychiatric social work interventions from April 2020 to March 2021 was considered. Frequency and percentages were used to analyse the data. Results: Psychiatric social work services at the neurology emergency setting were started in July 2018. Social workers get referrals from triage (4 hours to 24 hours), followed by priority ward (72 hours to 2 weeks), observation ward (72 hours days - 2 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 was 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, 2.5% working with unknown patients and tracing their family members. Most of the patients were diagnosed with a stroke, GBS, neuro-infections, and a few seizure disorder patients who sought psychiatric social work services in emergency and casualty settings. Assessment of their functionality revealed that 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 was an education about the illness, facilitating poor patients to avail social welfare benefits, supportive psychotherapy and crisis intervention.

Keywords: Crisis intervention, acute care, medical social work