IM: Is it Always Appropriate?

IMs, intramuscular injections, a topic I never wanted to have personal experience of, I never wanted to have my own personal opinion on, but unfortunately I do. I think that IM medication is something that needs to be approached in a very sensitive way when professionals are considering using it. It should not be used as a threat to the patient, whether that be just mentioning it or actually carrying out the injection but it is also important that the professional involved thinks about the possibility that it could traumatise the patient involved and any patients witnessing the IM. If IM is the best course of action and is appropriate then it must be done in the least traumatising way for everyone involved.

I want to make it clear that there have been times when IM medication was helpful to me and was used in an appropriate way. I do, however, feel it is important to share a negative experience of ‘being IM’d’ because the way in which it was used was unfair and somewhat traumatising:

The 31st December 2014, I was detained under Section 2 of the Mental Health Act and out of fear, shame and hopelessness I ran out of the assessment and found myself wandering the streets in the dark on my own. My thoughts were racing, I was lost and grasping hold of the occasional rational thought that fleeted through my mind was nearly impossible but I ended up phoning the police as I knew they were looking for me and telling them where I was. I was taken back to the ward and it’s a bit of a blur but I engaged in self harming behaviour. I was marched up to the clinic room with an elbow digging into my spine, I was telling them they were hurting me but it didn’t stop them. They put a pot of tablets in front of me. I struggle to take tablets at the best of times and there were so many, these were not my regular medication and so I asked what the tablets were. The nurse responded by saying that she was not ‘playing games’. I took a few of the tablets and then said that I couldn’t swallow anymore before asking again what the tablets were to which the nurse responded, “I will IM you!” I was upset enough without being threatened, I’d never been IM’d before, I wasn’t even sure of what it meant. I ran out of the clinic room and went and laid in bed.

I was in a dormitory and there was another young woman in the room when the nurse came in accompanied by two or three people. I think I put up a verbal fight, but I can’t really remember. They all held me down whilst the nurse injected me. I then slept until the 2nd January 2015. Over 30 hours of medication induced unconsciousness. An entire New Year’s missed-although that was the least of my worries but it still matters to me.

In this particular situation I feel things could’ve been handled differently. Firstly, where was the protection for the other patient? I would be distressed if I had to witness someone being injected against their will, I imagine that it has affected the other patient. Also, what about my privacy and dignity? Now I am feeling more stable I’m not very happy that another person witnessed that happening, I would much prefer that it was only the staff and myself that knew about it. How could that have all been prevented? They could’ve asked the patient to leave the room for five minutes. That’s all it would’ve taken to protect her and to respect my privacy and dignity.

Should medication ever be used as a threat or in a threatening way? No. That is the simple answer, just no. There are many other ways that the nurse could’ve worded it, perhaps in a caring and compassionate way. I also wonder if the nurse would’ve told me what the medication was and would’ve listened to me saying that I struggle to swallow tablets, would the situation have been very different? I do feel that listening to why the patient isn’t taking their medication is of key importance in these situations. I’ve had other nurses say similar when medication has been refused, “I’ll give you an injection, is that what you want?!” No, what I want is for you to listen to my concerns and worries about the medication you are forcing upon me.

Yes I was distressed, yes I needed some help but was it appropriate to restrain me and inject me with something so strong I slept for two days? Was it appropriate to use IM as a threat? Or to do it in front of another vulnerable patient? I’m not so sure it was.

Mental health care services should not be causing trauma to their patients. It can be very isolating to have traumatic experiences like this. Personally I find it difficult to talk to my mental health team about the trauma they have occasionally caused me.

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