Submission Type

Case Report


Introduction: We report on a patient with untreated severe mental illness who presented with a life-threatening emergency: retained products of conception and hemorrhage.

Clinical Findings: A female patient experiencing homelessness developed life-threatening hemorrhage. Her mental illness impaired effective communication and treatment.

Clinical Course: The patient presented with fatigue, vaginal bleeding, and known retained products of conception. Her active mental illness complicated the situation as it limited effective communication and treatment due to delusions. She requested only treatment for an infectious cause of her symptoms. She refused most interventions and had a self-directed discharge from the hospital. Throughout this process, we assessed that she understood the implications of declining care, despite her mental illness. After extensive patient-centered and trauma-informed discussions, she accepted medical treatment.

Conclusions: This case highlights the importance of patient-centered communication and team-based care during emergencies and refusal of care. Shared decision-making and trauma-informed care are appropriate methods for assessing the capacity of patients with severe mental illness in acute and life-threatening conditions.



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