The Psychiatric hospital最新文献

Presented at the invitation of the President of the National Association of Private Psychiatric Hospitals, January 30, 1991, Marco Island, Florida, this paper is addressed to those whose interest in psychiatric hospitals centers around quality-of-care issues and who today are concerned about the deleterious impact of many forces upon the quality of hospital care. The author begins with comments about systems under stress, then turn to the quality-of-care issues, and end with some speculations about the future of psychiatric hospitals.

Current reimbursement trends are forcing a search for less expensive alternatives to hospitalization for the mentally ill. Much of the literature on the treatment of patients with severe borderline personality disorders has focused on inpatient treatment, often on the pros and cons of long-term versus short-term programs. Little has been written about the treatment of patients with borderline disorders in partial hospitalization programs. This paper emphasizes the usefulness of such a setting and describes its staffing, program components, and approaches for intensive reconstructive treatment. Special emphasis is placed on admission and discharge boundaries, careful coordination of treatment, and crisis management.

In the 1980s there was overbuilding of facilities of all kinds, including facilities with acute psychiatric beds. A subsequent decrease in patient days in most of these hospitals caused significant excess capacity. With all the problems now confronting mental healthcare facilities, it may be difficult to focus attention on hospital buildings; however, intelligent planning for the use of these large investments may be part of an overall solution. An awareness of problems facing our facility managers should enhance the planning process and minimize unwanted surprises.

The demands on the design and subsequent built environment for psychiatric treatment are exacting. Inside and out, the facility must offer a safe, comfortable, nonthreatening, readily comprehensible set of surroundings to support the therapy taking place there. All messages sent by the environment must convey sincere respect for the patient and sensitive concern for his or her physiological and psychological well-being.

The National Association of Private Psychiatric Hospitals (NAPPH) initiated the Critical Indicator Project in 1986 to develop measures of quality and other important clinical aspects of inpatient psychiatric treatment. The tools used to collect data have undergone extensive refinements, and the data collected have been analyzed by researchers and clinicians. After careful review, in January 1990 the NAPPH Board of Trustees endorsed full implementation of the Critical Indicator Project in all member hospitals. This paper describes the project and its current major implications.

A 130-bed private mental health hospital in Ann Arbor, Michigan, was a state-of-the-art, progressive facility when it was built in 1986. Since then, changing reimbursement patterns and the shift from inpatient to outpatient services have led to an organizational and physical reconfiguration of the facility to accommodate both mental health and chemical dependency programs. This paper describes the original design of the building and how it was modified in 1990 to achieve organizational objectives and enhance patient care.

The field of geriatric mental health is confronted with the dilemma of a sharp rise in the elderly segment of the population and a concomitant shortage of age-appropriate psychiatric intervention services. There is tremendous need for specialized hospital-based intervention for older adults with mental health problems. A creative and rapid response is imperative and should be based on a continuum of geropsychiatric services that includes acute inpatient, partial hospitalization, and outpatient services. Because Medicare reimbursement for partial hospitalization is restricted to hospital-based programs, private psychiatric hospitals are uniquely positioned to assume a dominant role in the geriatric mental health service delivery system. This article details one hospital's specialized, intermediate-term partial-hospital program for older adults. Partial hospitalization is demonstrated to be an essential component of comprehensive geropsychiatric services that can overcome problems of cost-effectiveness, accessibility, and acceptability to consumers--all factors that presently restrict the development and use of such programs. Based on empirical findings, clinical adaptations to assessment and treatment procedures specific to older adults are presented.

Violence perpetrated on the staff in our psychiatric hospitals is increasing. We believe an in-hospital support group for employee victims of violence is an effective and economical means of helping our staff, our patients, and the hospital in general. We believe that it is crucial to provide education about and to foster sensitization to issues of violence and that our staff must work together within the facility and with outside agencies, such as those in the legal system. We are just starting our support group at the Carter Center, and this paper discusses various practical points encountered thus far and some of the theoretical issues surrounding our beginning. We believe ours is an important prototype of staff support groups, which are vitally needed. I hope to publish a follow-up report on our group and the progress it has made.

Current and anticipated changes in the mental healthcare delivery system demand a comprehensive facility planning process. As reimbursement for acute care decreases and the influence of managed care increases, most private psychiatric hospitals will need to develop a facility master plan to best use their current buildings and property. The facility master plan will become a road map and provide a logical route for expanding, modifying, and using current hospital assets during the changes imminent in the years ahead.

Safety in the psychiatric setting involves many aspects of facility design, renovation, operations, training, and administrative control. Through the application of a systematic hazard-control program, risks may be identified and action taken to reduce or eliminate the potential for accidental or self-inflicted injuries. This paper addresses specific aspects of the hazard-control process and its application at The Sheppard and Enoch Pratt Hospital, Baltimore, Maryland.