Trolling other people's messaging boards is not usually something I do or recommend, but this conversation offers valuable information for us all to live by. I've edited the material down and, of course, removed the names to protect those unaware I was looking in. (Based on their experience, which you will read below, it would be unfair to call them innocent.)
Subject: pencils for psychiatric patients
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From: Forum Starter
Date: Thu, Feb 19, 2009 at 8:56 AM
To: Group
A quick question: I'm starting a journaling program on an acute inpatient unit and was wondering if anyone knew of any resources where I could order pencils or other writing utensils that would be realitively safe for patients to use independently (if they are not judged a suicide or assault risk), I'd appreciate it.
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From: Responder 1
Date: Thu, Feb 19, 2009 at 9:38 AM
To: Group
Just a suggestion.....consider using any felt tip markers instead of pencils. They are less likely to pierce skin or contribute to serious self injury. They also won't require a sharpener. It is difficult to predict behaviors of in-patient populations.
Good luck.
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From: Responder 2
Date: Thu, Feb 19, 2009 at 10:14 AM
To: Group
What is your concern about pencil safety? I use pencils with children all the time.
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From: Responder 3
Date: Thu, Feb 19, 2009 at 10:30 AM
To: Group
I currently provide services for individuals diagnosed with a severe and persistent mental illness and I have never had any problems with providing them with pencils. If you have a concern, which you really shouldn't, incorporate and educational segment into your group demonstrating the proper use of pencils.
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From: Responder 4
Date: Thu, Feb 19, 2009 at 10:40 AM
To: Group
I treated a boy who did in fact stab other children and adults with pencils and did kill his cat with one. Your instincts are right to be concerned regarding inpatient treatment, pencils and safety.
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From: Responder 5
Date: Thu, Feb 19, 2009 at 11:00 AM
To: Group
Although I don't know where to find them, special small flexible pens are available. They have been used inside the max prisons. I have seen them in prisons I have worked in. They are supposed to be safer because they bend under the slight pressure. I have used them and the flexible and the small size can be annoying and takes a bit of getting used to. If you feel concerned about supplying regular pens or pencils, these may be an option.
Here is a tongue-in-cheek article that actually has a link to where one can purchase these pens. However, at $10 each, I doubt any Dept of Correction is paying that much. Maybe try calling prisons to request more information about this. Good Luck.
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From: Responder 6
Date: Thu, Feb 19, 2009 at 11:02 AM
To: Group
Hi may I suggest offering oil pastels as an alternative for your patients to use independently. That way you'll sleep better!
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From: Responder 7
Date: Thu, Feb 19, 2009 at 11:17 AM
To: Group
I am aware of an woman who stabbed herself with a pencil and another woman who rubbed her skin raw with the eraser; scars remained. Both were inpatient at the time. If you are working with folks who self-harm, some will find most any way to self-injure.
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From: Responder 8
Date: Thu, Feb 19, 2009 at 11:22 AM
To: Group
I think Responder 1 & Responder 6 have some good suggestions, as this is a valid safety concern on an inpatient unit... Soft Pastel pencils, may also be an additonal option to consider.......
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From: Responder 9
Date: Thu, Feb 19, 2009 at 12:53 PM
To: Group
I worked with inpatient children and adolescents and this was always a concern. Before and after group sessions, I always counted my pencils to make sure no patient took one. They were only allowed to use them during structured group with supervision. A fellow staff member was stabbed with a pen, and adolescents had stolen pencils in the past to cut themselves with the metal that held the eraser. You can NEVER be too cautious on an in-patient unit. Always yield on the side of safety.
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To: Group
From: Responder 1
Date: Thu, 19 Feb 2009 14:38:43 +0000
Just a suggestion.....consider using any felt tip markers instead of pencils. They are less likely to pierce skin or contribute to serious self injury. They also won't require a sharpener. It is difficult to predict behaviors of in-patient populations. Good luck.
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From: Responder 10
Date: Thu, Feb 19, 2009 at 2:27 PM
To: Group
We use the small miniature golf pencils on our psych units because a previous patient stabbed a dr. in the ear w/ a regular pencil. I will give the pts., crayola markers (fat ones) as they are not sharp and wash off the walls w/ soap and water; pencils and crayons do not.
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From: Responder 11
Date: Thu, Feb 19, 2009 at 4:21 PM
To: Group
I understand the concern, but I do end up using regular pencils. Another option is golf pencils, kind of too short for really effective stabbing and without the metal at the end that could be removed and potentially used for cutting.
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From: Responder 12
Date: Thu, Feb 19, 2009 at 4:25 PM
To: Group
You might try woodless pencils if you are looking for something erasable. You can get them at the art supply store near the drawing pencils. They might be a little thick for writing, but there is no metal or wood. It might not be ideal, but they can be sharpened enough just by rubbing the side of the pencil on the paper. If you broke them in half they would be pretty safe.
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From: Responder 13
Date: Thu, Feb 19, 2009 at 11:43 PM
To: Group
Just a quick side note regarding giving patients markers vs. pencils. We once discovered that a pt was given markers to use in his room unsupervised and later discovered that the pt put a marker in his anus. I do not allow pts to have anything unsupervised with the exception of golf pencils. However, having said this, I have never had such an experience like this before or after this particular incident.
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From: Responder 14
Date: Fri, Feb 20, 2009 at 7:22 AM
To: Group
THanks for everyone's ideas about the pencils. I am enjoying this
conversation about materials.
What's so special about golf pencils? I believe you could put one in one's anus or stab someone with them. I often work with drawing materials. For drawing I tend to use markers, oil pastels, charcoal, or crayons, regular or super fat for kids. I suppose in a hospital setting, almost anything is possible to use for some abusive purpose to self or others.
I've been wondering for some time how to safely use fingerpaints, even in a private practice setting, without ending up with a huge mess - thrown paint comes to my mind. (My space has a carpeted floor.) Maybe it has to be used in a space where a water based clean-up of EVERYTHING is easy.
THanks again to all for their input and ideas.
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From: Responder 15
Date: Fri, Feb 20, 2009 at 5:20 PM
To: Group
One thing to consider regardless of the art tools used is that if there is a real concern with a patient using them then you should get the psychiatrist to write an order allowing the use of such tools. That way the doctor, and hopefully the treatment team, would be aware of what you're doing. Plus it would probably get you off the hook if something were to happen.
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From: Responder 16
Date: Fri, Feb 20, 2009 at 5:54 PM
To: Group
Markers... patients in psych setting will swallow them. It does a real number on them too. I really love those peeling crayon pencils. I think in the catalogue they are listed as crayons, you could also get grease pencils. Stay away from the charcoal, the noise would drive you nuts. For journaling the golf pencil might be the least frustrating for them.
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From: Responder 11
Date: Fri, Feb 20, 2009 at 6:23 PM
To: Group
it's only that golf pencils are short, and this makes it harder to grip them as one would have to in order to use them as a stabbing weapon it's true, if there is a will, there is a way...one can make weapons of many things
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From: Responder 17
Date: Sat, Feb 21, 2009 at 6:36 AM
To: Group
I noticed that so many people responded to Forum Starter's questions, which I found very important. I have been working for adult psychiatric inpatients for a while. Thus Forum Starter's question is not foreign to me. My experience resonate with some of your responses as well.
There are few things that I consider when I pick art materials for acute, psychotic patients with unpredictable behavior. Of course we can not work with them unless their doctor believes that person is ready for therapeutic activities and treatment. It may depend on where you work.
1. How many people in your group or individual?
2. Functioning level of the person in your group, individual session?
3. Is there any system for calling for assistance? Do you work with another staff member or assistant?
4. Combination of group members. (What kind of unpredictable behavior may happen?)
5. Facility policy on safety. (Only use of nontoxic materials ...)
6. What material you find comfortable to use?
7. My ultimate suggestion is just use paper, which people might swallow, or get paper cut but less hazardous comparing traditional art materials. etc.
I found it useful to use Origami as a tool for my patients which may not suit you and your population. It seems, touching colorful paper has soothing effect also. If only you know how to fold origami and you are comfortable presenting...
I'm not sure that origami is ideal for journaling, which was what Forum Starter was initially asking about, but Responder 17's heart is in the right place.
What's amazing to me about this exchange is that these are legitimate, professional concerns for some people in the world. At my job, I sometimes wonder if I've brought enough food for lunch. Occasionally, clients aren't crazy about what I've written for them. My computer crashed last week, and I've felt a bit discombobulated this week, while we worked toward a solution.
I never -
never - look at my Slinky full of pens and wonder if I should stab a cat or shove one up my anus (although now it'll be hard for me to resist thinking of those things, even if I still have no desire to actually do them). If I did, I'm not sure my colleagues would be equipped to handle it like the fine professionals above.
But I finally understand why they use golf pencils at country clubs around the nation: they keep stabbings to a minimum.
Labels: fun, observations, prison, work
