Another semi-interesting S/A request today, although this person had a psychotic disorder diagnosis independent of their drug use and was on court ordered treatment for it
Group home staff reporting that over the weekend this person went AWOL to do meth and have sex with homeless people, and that she (identifies as trans m->f) came back psychotic. I asked the staff are your residents allowed to come and go as they please and they were like “uh, no”
So the client who was wearing long hair and a skirt asks to talk outside on cramped patio. She positions herself directly facing me when I normally try to be slightly sideways because it’s less confrontational, but it was a cramped location. All I was thinking is please act like a proper lady and keep those legs together, I don’t need to see what’s up your skirt. Normally if a client is nude hanging dong or has their ass out I say “hey let’s get some clothes on or a blanket to cover up with, I’ll wait”. But with someone being just unaware they are flashing up their skirt I’ll won’t say anything and instead just keep eyes up for their modesty. But luckily, even in a psychotic state, she kept knees together like a proper lady /salute
But I wasn’t getting far in the assessment because she was pretty symptomatic, disorganized and often nonsensical communication. She did mention that she’s “from the streets” and that last weekend she left to do drugs with “friends”. And I’m thinking to myself “by friend you mean the homeless stranger that walks around outside naked sometimes? Yea the staff already filled me in on that”. But I didn’t say any of that
But I’d start a sentence and she’d frequently interrupt like “oh sorry for how I’m looking, Paul from the CIA is using my eyes right now and if I start snapping they are casting spells”. And I’m like “oh ok” and trying to keep my train of thought through all the random erratic interruptions
I am not getting far with the assessment because she’s too delusional but she did want to stay there so I ask what she plans to do the rest of the day then. And she says “well my court ordered treatment expires tomorrow so I’m thinking of going back to the streets then to see my friends again” and I’m thinking I can’t write that your plan is to go AWOL to do drugs and have sex with homeless men….
So was in a bit of a spot not wanting to leave her here in a psychotic state but she didn’t want to go anywhere but then police showed up. I had forgotten the GH staff had called them because the client was following them around in their personal space speaking nonsense loudly
And then the police put the client in handcuffs and said she had felony warrants in [x] county. I told them she’s not oriented to self, date or situation more as just a heads up (but they could already tell) and to ensure they have her re-assessed in jail
That was the end of that. There is a summary billing code I can use for client was arrested mid session
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