Random Spiel, Met An Old Patient Back in the Streets Again

I saw an old patient that was previously doing well prior to discharge roam the streets again. It was during commute when she licked another passenger's hands and this startled the other passengers. The shriek from the woman that had her hands handed fresh saliva gave the old patient the spooks that she ran off into the highway (she wasn't hit and I lost my vision of her in traffic). I spent the rest of the minutes hearing the victim retell how horrible the experience was.

My thought process during the time when I wasn't looking at the patient and I heard the woman was licked and her hands too: Ok, that's someone clearly not in the right state of mind.

My thought process after seeing the familiar face: Yep, I know her.

My thought process after thinking about the context of being licked: Maybe it was by accident that she was licked as the money being passed went through the patient's hands and the patient was drooling. A side effect of Risperidone as an antipsychotic was excess saliva, perhaps due to poor hygiene sense, the patient's hands were used to catch drool and because she had to pass the money, that meant soaking the cash in drool while also adding more drool to towards the hand contact.

That's how I've deduced the situation going down and it fits the mental framework the way I solve cases, Case closed.

Whenever someone is being aggressive or irritable, the first thing that comes to my mind isn't oppose but to understand where they're coming from. I've seen people not act or think rational so seeing someone who is known to be sane acting insane hits different. It's like having a familiar friend with an attitude, normally you get to tolerate their BS cause you have some emotional investment there but if some stranger throws the same attitude towards you, it becomes unacceptable.

Oh... the guy pulled his pants down in the sidewalk and started masturbating?

I know that's odd behavior but the first question that pops up was whether this guy was having an intellectual disability, under a psychotic/manic episode, and less focus about the obscene display. But I know a layperson would take it upon their hands to do something about it like beating the shit out them or avoid them like the plague. This is what exposure to the mentally ill did to me, I don't go attack mode because someone threw a hissy fit or picks a fight at random because sometimes it's really what it is, random and they might just be listening to the voices in their head.

I've had a patient on their manic face lunged at me but their efforts got thwarted by a car door. They should've got off the car first before they started being aggressive. But these violent episodes happen less often than people think but that doesn't stop anyone who isn't compassionate about the mentally ill to be understanding. Like I said, I've seen people who tell they advocate mental health as a lip service but the moment they get handed a clinically insane person upfront, they'd pass off the responsibility to our department despite the behavior being controlled at some other ward.

Often times, the patients we discharge were doing so well in terms of their clinical progress but once they get out, their folks just fail to watch over them that they end up relapsing. There's a limit to what you can do as an institution because when the public cries out why isn't the government doing anything about the mental health problem, there is something that is being done but there's not much that can be done when the ones perpetuating the problem are family members that couldn't give a fuck about their own patients well being. It's a vicious cycle.

Just some random musings from the Psychiatric Department.

Thanks for your time.