Clinical Interventions in State Psychiatric Hospitals: Safety and Logistical Considerations

Abstract

ABSTRACT Adaptations are frequently made by hospital administrators, clinicians, and other staff to accommodate for the changing populations of state psychiatric hospitals in the United States. For example, many mental health treatments, including evidence-based treatments, have been adapted for use with forensic patients and in forensic settings. Specialized ethical guidance has also been developed for working with forensic patients. However, there is a gap in the literature regarding the logistics of safely conducting therapeutic interventions and assessments in environments that were not designed for forensic populations, or individuals with intellectual and developmental disabilities as primary diagnoses. Further, most training programs for mental health clinicians do not include specialized training for working in inpatient psychiatric settings, including state psychiatric hospitals, and so it often falls to training sites to provide that foundational knowledge. The current manuscript describes the context and practical challenges mental health clinicians across disciplines may face in providing services to clients in inpatient settings. Recommendations for maximizing safety of all persons, while simultaneously attempting to protect the privacy of the patient in the course of clinical interventions, and maintain the integrity of clinical interventions administered in inpatient settings, are also discussed. Recommendations are based on a review of the literature and the professional experiences of the interdisciplinary research team in several state hospitals across the United States. The target audience of this manuscript includes clinicians and trainees who are new to working in inpatient psychiatric settings, and seasoned clinicians adjusting to the changing demographics of state psychiatric hospitals.