The Psychiatric hospital最新文献

Earlier this year, the National Association of Private Psychiatric Hospitals brought together a group of experts to reexamine and update the Association's position on inpatient treatment for alcoholism. The resulting white paper explains the role of the hospital in the treatment of various types and degrees of alcoholism, including alcoholism that coexists with significant psychiatric illnesses. This document is meant as a springboard to discussions both within the hospital and with those outside the hospital (insurers, employers, case managers, benefits managers) whose decisions have a critical impact on treatment options.

A methodology review synthesizes 32 outcome studies of child and adolescent inpatient psychiatric treatment published since 1975. The principal finding is that conceptual and methodological shortcomings plague the majority of studies, suggesting that findings are less clear than typically believed. Recurring problems include sketchy, if any, data on diagnostic criteria for subject inclusion, lack of control groups, limited information on prior treatment, inadequate description of the hospital setting and active treatment ingredients, infrequent blind analysis, sparse outcome data, and a nonstandardized approach to collecting information. Eight recommendations are offered to assist researchers in conceiving and designing future investigations.

Behavior therapy has been underutilized in the private psychiatric hospital setting. A recent survey of member hospitals of the National Association of Private Psychiatric Hospitals (NAPPH) found that fewer than 25 percent of those surveyed provided behavior-therapy consultation for inpatients and fewer than 40 percent had a behavior therapist on staff (1). This situation is unfortunate because behavior therapy has made significant contributions to the mental health field, and the approach offers a research-based system of accountability and cost-efficiency. Moreover, behavior therapy is applicable to a wide range of psychiatric problems, and its methods and procedures provide a practical and effective complement or alternative to a patient's pharmacotherapy and insight-oriented psychotherapy. Clearly, behavior therapy has much to offer the private psychiatric hospital, and this contribution is gradually being recognized. This paper describes the development and growth of a behavioral-consultation and treatment program in a private psychiatric hospital.

A substantial increase in severely disturbed adolescents, along with the dissemination of relevant clinical theory and research-proven clinical procedures, have resulted in an expanded utilization of hospital treatment for adolescents. More than ever, the clinician needs guidelines for decision-making regarding hospitalization, treatment goals, length of stay, and treatment models. Despite the expense, despite the frustration, and beyond the pain of failure and uncertainty, we are compelled to employ our current knowledge if we are not to waste the many young people who can be brought to productive adulthood through hospital treatment.

In the search for cost efficiency, psychiatric patients are experiencing greater restrictions on their insurance benefits. Managed psychiatric care may provide a useful alternative to arbitrary benefit limits, but may also interfere with treatment, especially if there is a disagreement between the manager and the responsible clinician. Three clinical vignettes are presented and the implications of possible premature discharge described as a first step in building a research agenda on the clinical consequences of managed psychiatric care.

Much has been written about the future of state hospitals for the mentally ill; however, their precise role in a system committed to community care has yet to be resolved. Ethical and moral dilemmas characterize the debate and focus on the notion that community care is preferable to hospitalization. Missing from these discussions has been the realization that a majority of chronically mentally ill persons are below the poverty level and are dependent upon the public sector for their care. Particularly relevant to these discussions are the needs of those chronically mentally ill persons who are homeless. This paper describes a follow-up study of patients released from hospitals and the process that leads to homelessness. The role of the state hospital in providing services to this population is examined from the vantage point of these individuals receiving care elsewhere.