Thanks for posting this. I see mention in this thread of ED social workers (I am one). This is definitely a social work call...but I'll be honest, we don't have a good fix for this either, and these are very much the cases that cause compassion fatigue.

There are so many different variables playing into these cases that keep real change from happening. If this case came in at night, social work would triage it far lower than impending deaths, bad traumas, and mental health crises... and I would assume the rest of the team would do the same. It's so messed up, but on most nights this patient just wouldn't get enough of our time.

The outside system is equally screwed up and the waitlists for some of the more useful harm reduction programs (like a wet house, where he can keep drinking but in a slightly more supervised context, have regular therapy, and slowly build motivation to make a real lasting change) have waitlists years long.

The other major part of this is that even the most symptomatic psych patients and the active users - they can still very accurately perceive our frustration and occasional lack of empathy, and they react as most of us probably would - they feel worse, and they don't feel like they have the strength to change.