NP sends homicidal and suicidal patient home because she didn’t want to force family to take them to the hospital

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Actively psychotic, suicidal, and homicidal. What could possibly go wrong when an NP is involved?

Originally posted on Reddit. Edited for grammar and clarity.

I’m a mental health clinician (clinical social worker) at an outpatient mental health clinic and had just met with a patient a week earlier. He was a 17-year-old male with early signs of psychosis. This patient needed an urgent psychiatry evaluation to fully assess and properly diagnose and he was waiting for an appointment with our psychiatrist. I felt so bad for the parent who was in such denial that their child was quite unwell.

I guess later on that week, the parent took the patient to their family physician’s office for a second opinion and met with an NP. Sometimes communication lags between us and the family doctor. I usually call their RN with a quick update but hadn't gotten around to it yet. I get a call from the NP who described to me in detail this patient’s plan to murder a specific individual and how he was going to do it, and when he wanted to do it. There were delusions, auditory and visual hallucinations, and command hallucinations that the patient did not originally disclose to me. The NP proceeds to tell me that the patient was so distressed by these thoughts that he said he couldn’t handle the voices telling him to go murder this other person, and that he was seriously thinking of killing himself (had a plan and method). There were other factors that made him high-risk.

I ask when they attended the ER. I shit you not, the NP said the parent didn’t want to take their child to the hospital because they had to go back to work and wanted to wait things out. She asked me to call the parent to tell them the patient needed urgent medical attention because she didn’t want to ruin her rapport with the family.

A few weeks prior, the patient saw the same NP who diagnosed him with anxiety and started an SSRI. She tells me, "I stopped the SSRI so things should improve" (?!?!?)

Then the NP asks me, "What should I do next?" "What would you recommend?" I'm not a fucking doctor. Then she says that she’s also waiting for another physician at her practice to weigh in on whether or not an SSRI can cause psychosis.