Present status and future needs of psychiatric facilities in general hospitals in the United States and Canada.

Abstract

Present psychiatric facilities in general hospitals are extremely inadequate. Only 279 of 4,761 United States general hospitals offer any kind of adequate inpatient psychiatric service. Although half of all hospital beds are now used for treatment of chronic mental illness, yet general hospitals provide only 4% of beds for acute psychiatric disorders. Psychiatric personnel is below minimum numbers. Training programs are insufficient to meet the demands, as witness 14 completed units unable to operate for lack of personnel. Only 309 of the total 4,761 general hospitals train psychiatric personnel. Medical schools do not place enough emphasis on psychiatric teaching, training, treatment, and research in general hospitals. Only 52 of the 73 medical schools use them, and only 9 use all clinical departments for the integration of psychiatry. Voluntary health insurance coverage of psychiatric disorders is disgracefully lacking. Only 10% of Blue Cross and 4% of Blue Shield plans studied provide the same benefits for psychiatric as for other medical disorders. The rest discriminate as to days, benefits, or dollar maximums. Half completely exclude psychiatric problems. In view of these urgent deficiencies the following recommendation has been made: that psychiatrists give attention to general hospital problems in order to help integrate psychiatry into medicine, thereby reducing chronic mental illness and providing beds for private-practicing psychiatrists.