The Psychiatric hospital最新文献

Measures of weight were obtained both at admission and at discharge for children and adolescents receiving inpatient services at a private psychiatric hospital. The sample included 20 males and 20 females from each of three units: child psychiatric, adolescent psychiatric, and adolescent substance abuse. The difference between the actual weight change of the subjects and the weight change predicted from growth charts was obtained. Overall, subjects gained a significant amount of weight. The actual mean increase in weight was roughly 3.5 times greater than the predicted increase, and there were no significant differences in weight gain between males and females among patients from each of the three units. Potential explanations for this increase in weight are explored, and the implications are discussed.

A follow-up of sixty young-adult psychiatric patients hospitalized at least six months revealed that, at one to three years post-discharge, 83 percent were living in the community. Nearly two-thirds of the 60 patients were actively involved in aftercare treatment. A method of categorizing outcome based on overall level of functioning revealed that good outcomes occurred even among patients whose prognoses, based on treatment history and diagnosis, might be considered guarded. Findings are discussed in relation to the need for information on the efficacy of long-term psychiatric inpatient treatment and the identification of patients who might benefit from this form of care.

Managed mental health companies are gaining tremendous power in the delivery of behavioral health services. Contracts can literally shift market share from one facility to another in a matter of weeks. For most inpatient providers, managed mental health bodies ill in the forms of fewer admissions, shorter lengths of stay, and lower service fees. The first section of this article explains some of the factors driving the growth of managed mental health care. The second cites the benefits of developing a hospital-based managed mental health service.

The National Association of Private Psychiatric Hospitals (NAPPH) recently joined with the American Association for Partial Hospitalization (AAPH) to provide mental health professionals with a clear, industry-supported definition of psychiatric partial hospitalization, an option on the continuum of care used by clinicians to treat mental illnesses. In 1988, Congress approved a major benefit change for the Title XVIII Medicare program by including reimbursement for partial hospital programs that meet a strict definition and provide a series of treatment services. As defined by Congress, partial hospitalization means an outpatient program specifically designed for the diagnosis or active treatment of a serious mental disorder when there is a reasonable expectation for improvement or when it is necessary to maintain a patient's functional level and prevent relapse or full hospitalization. That definition and the service components are endorsed by NAPPH and AAPH, and they offer a model for other insurers or employers considering the addition of this highly specialized program to healthcare benefit plans. Partial hospital programs are usually furnished by a hospital as a distinct and organized intensive ambulatory treatment service of less than 24-hour daily care. Partial hospitalization is not a substitute for inpatient care. For some patients, the availability of partial hospitalization may shorten the length of stay of full hospitalization or serve as a transition from inpatient to outpatient care. It may allow some patients to avoid hospitalization. Placement in a partial hospital program is a clinical decision that can be made only by a physician thoroughly knowledgeable about the patient's illness, history, environment, and support system.

An "irresistible force" has surely emerged in American healthcare; its name is Managed Care. It's a force embarked on an economic holy war, fired by the passions and anxieties of a competitive market economy that now seems uncommitted to spending more on health services. Its army is made up of an ununited confederation of utilization review organizations, health maintenance organizations (HMOs), preferred provider organizations (PPOs), exclusive provider organizations (EPOs), and a number of other entities that have been enlisted to restrain++ the medical-industrial complex. In their march across America, they have frequently assailed the shibboleths and established structures of treatment systems, especially psychiatry and often fought with one another. While some are mercenary forces, others appear as peoples' armies, committed to preserving and strengthening the healthcare system they are transforming. As it encounters the inhabitants of this domain, Managed Care becomes both their master and their slave. As with any occupying force, it must win their hearts and minds over to the new way of doing things. The winning-over process is not going well now. Many patients and providers are angry at the inefficiencies, unproven effectiveness, administrative burdens, affronts to traditions, and threats to quality sometimes posed by Managed Care. This collective unrest has resulted in both a mounting resistance to the problems emanating from managed care changes in the healthcare system and a call to check its unrestrained incursions into professional practice through regulation. The growing tension between what seems an irresistible force and an immovable object can be viewed as part of the natural evolution of all change, particularly in a free market or in a society with requisite checks and balances.(ABSTRACT TRUNCATED AT 250 WORDS)

The civil rights and deinstitutionalization movements of the 1960s gave rise to legal and ethical challenges to the physician's authority to prescribe psychoactive medication to patients who refuse such medication. While no definitive legal ruling has been rendered in this area--and may never be rendered--a review of the important cases to date identifies consistent themes of patient competency, the possibility of physical threat, risks versus benefits, due process, and patient advocacy, all of which form the framework for intervening with patients who choose to refuse medication while preserving their right to do so.

Recent reviews of alcoholism treatment have argued strongly against the efficacy of inpatient treatment for alcoholic patients. This paper briefly considers the findings those reviews were based on and highlights some of the flaws that have led to the conclusion that inpatient treatment for alcoholism is unsuccessful and unnecessary. This paper suggests that the negative reports about inpatient treatment are biased and argues for the effectiveness of inpatient treatment, especially for patients with severe alcohol dependence or extensive social, psychiatric, or medical comorbidity.