General Hospital Psychiatric Unit Research Articles

Closing Doors on Acute Psychiatric Units: Time to Change?

Back to table of contents Next article Taking IssueFull AccessClosing Doors on Acute Psychiatric Units: Time to Change?Jon Gudeman, M.D., Jon GudemanSearch for more papers by this author, M.D., Medical College of Wisconsin, MilwaukeePublished Online:1 Sep 2005https://doi.org/10.1176/appi.ps.56.9.1047AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In acute psychiatric units in general hospitals and in psychiatric hospitals the doors are locked. Restricting the patients to locked units may be unnecessary or inhumane. However, there is resistance to opening the doors. The rationale for locking the doors focuses on at least three factors.The first is danger for the patient and the community. There is widespread fear that if the doors are unlocked, patients will leave the unit and harm themselves or others. However, this fear is often exaggerated. A vast majority of patients can take responsibility for themselves.Acutely dangerous patients often need restriction to their rooms, medication, and occasionally restraint. As these patients improve they need space restrictions until they are fully in control. This restriction can be accomplished with individually tailored treatment plans and programs on the ward or unit.The second factor is staff control and convenience. Staff will say that they feel more secure when the doors are locked. They do not have to watch the patients quite so closely or communicate with the patients as much or as often. Also, frequently staff can remain in the nursing station. When one unlocks the doors it is sometimes necessary to assign a staff member to the entrance to have patients sign in and out, and the staff member must know which privileges are ordered. This change requires staff to spend more time with patients and provides more education for the patients. Patients can talk about themselves, their wishes, and their desires, if one takes the time to listen. When patients cannot assume responsibility, they need ward or room restriction and limits. They should receive these restrictions only after demonstrating the need.Finally, stigma and hospitalwide resistance play a part in keeping the doors locked. Persons with mental illness are not particularly welcomed into general hospitals or communities. They are looked at with fear and sometimes disdain. This stigma means that opening the doors will require education and support. To open psychiatric units requires cultural change, just as the integration of race and sex on the wards required change. Taking the bars from windows and chains from the patients 200 years ago also required a change in attitude.When units have been opened, few disasters have occurred and patients are less stigmatized and are better able to integrate into the community. Hospitals should open the doors on psychiatric units to provide a less restrictive environment. Results should be evaluated objectively. Shorter stays, less need for control, healthier outcomes, reintegration into the community, and less stigmatization may all occur. FiguresReferencesCited byDetailsCited ByStigma and attitudes towards restrictive practices in psychiatry among psychology students: a network and path analysis study in an Italian sample27 January 2021 | Journal of Mental Health, Vol. 31, No. 1Frontiers in Public Health, Vol. 6International Journal of Mental Health Nursing, Vol. 21, No. 1International Psychogeriatrics, Vol. 23, No. 2 Volume 56Issue 9 September 2005Pages 1047-1047 Metrics PDF download History Published online 1 September 2005 Published in print 1 September 2005

Trustees Back Recognition Of Same-Sex Civil Marriage

Trustees Back Recognition Of Same-Sex Civil Marriage

The reform of the Greek mental health services

Background: The Greek Psychiatric reforms began in the early 1980s with the introduction of the National Health System and the financial support of the then European Community.Aims: To describe the ongoing process of psychiatric reforms and the current situation of mental health services in Greece.Method: Official reports and relevant publications were used as information sources.Results: The de-institutionalization of patients from psychiatric hospitals has almost been achieved. Psychiatric hospital beds have been reduced, psychiatric units in general hospitals have been developed, a substantial number of community mental health services has been established and the standards of care have been improved. New legislation has been introduced and the stigma attached to mental illness is gradually reduced. However, psychiatric units in general hospitals and Community Mental Health Centres have not yet fulfilled their role as principal providers of psychiatric care, while decentralization, sectorization and completion of the network of mental health services are still to be completed.Conclusions: Although the process of the Greek Psychiatric reforms has been slow and laborious, the progress achieved is undeniable. The identification of problems and gaps together with a stronger collaboration and common efforts with the other European countries will ensure the firmer establishment of the reforms in Greece.

Group meetings of caretakers of patients with schizophrenia and bipolar mood disorders

Background:In India, there is a paucity of trained professionals to execute psychosocial interventions. Families are thus assigned the role of primary caretakers of individuals with chronic mental illness.Aim:To assess the perceived benefits and difficulties of group meetings among caregivers of persons with schizophrenia and bipolar mood disorders, and to evaluate the utilization pattern of general hospital psychiatric unit (GHPU) services by caregivers who regularly attend such group meetings.Methods:Persons with schizophrenia and those with bipolar mood disorders with associated psychosocial problems and on maintenance medication were identified at the Psychiatric Rehabilitation Unit of the Department of Psychiatry, Father Muller Medical College. Significant caregivers of the identified patients were informed about the group meeting. Group meetings were conducted for about 45 minutes once a month for caregivers of patients with schizophrenia and bipolar mood disorders. Data regarding the psychosocial aspects of caregivers were collected before entry to the meeting and after 17 months of their participation. Participants who attended the meetings irregularly were excluded from the study.Results:The group meetings led to effective monitoring of the functioning of individuals, a reduction in the subjective family burden and family distress, a better support system with adequate coping skills and good compliance with treatment programmes.Conclusion:Conducting regular group meetings for a homogeneous population at a GHPU is feasible and beneficial.

Perspective from a general hospital psychiatric unit

Perspective from a general hospital psychiatric unit

State of the science: Outcomes of acute inpatient psychiatric care

Identifying client outcomes related to nursing care is critical to establish empirical evidence that supports the effectiveness of psychiatric nursing. The purpose of this article is to conduct a methodological review of the literature that examines client outcomes after treatment in acute care inpatient psychiatric hospitals and psychiatric units of general hospitals. The databases Medline, CINAHL, HealthSTAR/Ovid HealthSTAR and psycINFO were searched for articles published between 1991and 2004. A review of literature was conducted of studies related to client outcomes after inpatient psychiatric treatment. Forty-seven studies were reviewed. There is a dearth of literature related to client outcomes after inpatient psychiatric treatment. The existing literature has conceptual and methodological limitations. The organization of psychiatric nursing care, in relation to outcomes is nonexistent in the literature. Outcomes that are sensitive to nursing care must be conceptualized theoretically and then examined empirically. The Quality Health Outcomes model is proposed to conceptualize outcomes of acute inpatient psychiatric treatment that are sensitive to nursing interventions and the organization of nursing care.

A history of Norwegian psychiatry.

In Norway the building of asylums started in 1855 with the establishment of Gaustad State Asylum. Until the 1950s Norwegian psychiatry was mainly a hospital psychiatry, strongly influenced by the pre-war German tradition. After World War II, it was influenced by British social psychiatry and American psychoanalysis. Psychiatric units in general hospitals were established in the 1960s onwards and outpatient clinics from the 1970s. During the last twenty years Norwegian psychiatry has taken a more biological trend with stronger emphasis on diagnostics and drug treatment. The increase in the number of psychiatrists and especially psychologists has been formidable during the last fifty years.

The Unholy Darkness: An Autobiography Sightlines: The View of a Valley Through the Voice of Depression How I Stayed Alive When My Brain Was Trying to Kill Me: One Person's Guide to Suicide Prevention The Thief of Happiness: The Story of an Extraordinary Psychotherapy Detour: My Bipolar Road Trip in 4-D

The Unholy Darkness: An Autobiography Sightlines: The View of a Valley Through the Voice of Depression How I Stayed Alive When My Brain Was Trying to Kill Me: One Person's Guide to Suicide Prevention The Thief of Happiness: The Story of an Extraordinary Psychotherapy Detour: My Bipolar Road Trip in 4-D

Forty years of deinstitutionalization of psychiatric services in Canada: an empirical assessment.

To empirically analyze the implementation of the policy of deinstitutionalization of psychiatric services over a 40-year period. We assessed the policy of deinstitutionalization in terms of the following components: 1) population-based psychiatric beds, days of care in psychiatric hospitals (PHs); 2) days of care in psychiatric units in general hospitals (GHs); and 3) per capita expenditures on psychiatric services. There was a rapid closure of beds in PHs in the 1970s and 1980s, but this was associated with an increasing rate of days of care in psychiatric units in GHs (that is, transinstitutionalization). It was not until the 1990s that the overall days of inpatient care began to decrease. Per capita expenditures on community-based psychiatric services increased throughout this period. Standardized rates reveal tremendous variation among the provinces in the timing and intensity of deinstitutionalization.

Malaysia mental health country profile

Malaysia is a tropical country in the heart of south east Asia with a population of 24 million people of diverse ethnic, cultural and religious backgrounds living in harmony in 330,000 km2 of land on the Asian mainland and Borneo. Malaysia, which lies on the crossroads of trade between east and west Asia, has an ancient history as a centre of trading attracting commerce between Europe, west Asia, India and China. It has had influences from major powers that dominated the region throughout its history. Today the country, after independence in 1957, has embarked on an ambitious development project to make it a developed country by 2020. In this effort the economy has changed from one producing raw material to one manufacturing consumer goods and services and the colonial health system has been overhauled and social systems strengthened to provide better services for its people. The per capita income, which was under US$1000 at independence, has now passed US$4000 and continues to grow, with the economy largely based on strong exports that amount to over US$100 billion. The mental health system that was based on institutional care in four mental hospitals at independence from British colonial rule in 1957 with no Malaysian psychiatrists is today largely based on over 30 general hospital psychiatric units spread throughout the country. With three local postgraduate training programmes in psychiatry and 12 undergraduate departments of psychiatry in the country—all started after independence—there is now a healthy development of mental health services. This is being supplemented by a newly established primary care mental health service that covers community mental health by integrating mental health into primary health care. Mental health care at the level of psychiatrists rests with about 140 psychiatrists most of whom had undertaken a four-year masters course in postgraduate psychiatry in Malaysia since 1973. However, there continues to be severe shortages of other professionals such as clinical psychologists and social workers in mental health services. There are a few specialists, and specialized services in child, adolescent, forensic, rehabilitative, liaison or research fields of mental health. In the area of services for women and children, as well as the disabled in the community, there are strong efforts to improve the care and provide services that are in keeping with a caring society. New legislation on these are being passed every year and the setting up of a Ministry for Women's Affairs is one such move in recent years. Mental health in Malaysia has been slow in developing but has in the past decade seen important strides to bring it on par with other branches of medicine.

What is the usual length of stay in a psychiatric ward?

Introduction:Admission statistics can provide valuable data for planning and policy in the NHS. However, there has been little agreement about meaningful ways of summarising and expressing such data. We set out to (i) explore the distribution of length of inpatient stay and to examine the most appropriate measure of central tendency; and (ii) examine the relationship between severity of mental illness and length of stay.Method:Length of stay was recorded for a 12-month cohort of psychiatric admissions to a district general hospital psychiatric unit. These data were compared with a previous cohort study and also with DoH statistics.Results:Length of inpatient stay followed an exponential decay curve. The median length of stay for all three cohorts examined was approximately 15 days. Absence of serious mental illness was significantly associated with shorter length of stay.Conclusion:Length of stay is not normally distributed and so the median value is the preferred measure of central tendency. All cohorts examined showed a median value of around 15 days. Large numbers of patients are admitted for a week or less which has implications for inpatient and community services. Qnt] Psych Clin Pract 2004; 8: 53–56)

Jesse Montgomery Mosher, M.D., 1864-1922.

Back to table of contents Previous article Next article Images in PsychiatryFull AccessJesse Montgomery Mosher, M.D., 1864–1922Irwin N. Hassenfeld, M.D.Irwin N. HassenfeldSearch for more papers by this author, M.D.Published Online:1 Oct 2003https://doi.org/10.1176/appi.ajp.160.10.1757AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Jesse Montgomery Mosher established the first U.S. psychiatric ward (1, 2) and inpatient medical and nursing student teaching program (3) in a general hospital. Clinical Professor of Insanity and Nervous Diseases at Albany Medical College, he envisioned Pavilion F as an alternative to the local almshouse and the distant asylum.In 1895, Mosher went abroad to study hospital care in Vienna, Berlin, and London. He came back determined to establish a psychiatric unit at Albany Hospital that incorporated moral treatment and the latest scientific findings. So unique was Pavilion F that the New York State Commission on Lunacy requested that an exhibit be built for the 1904 Louisiana Purchase Exposition in St. Louis. Clifford Beers (4) reported in his influential 1902 book that Pavilion F was the only psychiatric unit in a general hospital in existence at that time. During the first 20 years of its existence under Mosher’s direction, Pavilion F became a model for psychiatric teaching units in general and university hospitals. Units were established in Ann Arbor, Baltimore, Boston, and Edinburgh (3).From the start, bedside teaching was built into the clerkship. Nurses were central, as was family, to treatment and discharge planning. Transfers between hospital services and consultations were frequent. Monte was loved and admired by students and colleagues during his lifetime. After his death, Pavilion F was renamed the Mosher Memorial Pavilion.Address reprint requests to Dr. Hassenfeld, 18 Wilshire Dr., Delmar, NY 12054. Image courtesy of Albany Medical College. Jesse Montgomery Mosher

Psychiatric Services in Israel: Need for a Continuum of Care Model

Objective: To highlight the need for a continuum of care model for the delivery of psychiatric services in Israel. Conclusion: Crisis assessment teams working in the community in collaboration with community mental health clinics and inpatient psychiatric units are required. The community clinics should have the capacity for providing assertive outreach including home visits as required. General hospital psychiatric units that are able to treat both voluntary and involuntary patients are also needed. The psychiatric service needs to be responsive to special needs groups with high morbidity such as those persons suffering from first-presentation psychosis and post-partum psychiatric illness. Two case vignettes are discussed that demonstrate the need for a continuum of care model.

Diagnostic profile of inpatients as a determinant of length of stay in a general hospital psychiatric unit.

The aim of this study was to determine if the diagnostic profile of inpatients of a psychiatric unit in a general hospital influences the length of stay. The results of a retrospective survey comprising the first 16 years of operation of the Psychiatric Unit of the Ribeirão Preto General Hospital (PURP) showed that the progressive increase observed in the length of stay correlated with the increase in percentage of schizophrenia diagnosis, after the 8th year of hospital operation, and of affective disorders, after the 12th year. The length of hospitalization kept increasing until the 16th year, even though there was no change in the diagnostic profile of the patients admitted to the unit. In a prospective study encompassing the next six months, 61 inpatients were evaluated with the Structured Clinical Interview for DSM-III-R and the Brief Psychiatric Rating Scale (BPRS). The results showed that 82% of the inpatients fulfilled the diagnostic criteria for the schizophrenic or affective disorder spectrum at admission, with a discharge rate slower than for other diagnoses, although the length of hospitalization did not significantly differ among diagnostic categories. The results further demonstrated that in every diagnostic category more than 50% of the patients stayed in hospital for more than one week after reaching a BPRS score equal to 6, indicative of discharge. Overall, these data suggest that the increase in length of hospitalization may be due to a higher percentage of patients with a diagnosis of schizophrenia and affective disorder admitted to the PURP. In addition, patients with low symptomatic levels remained in hospital longer than they should have.

Possible PSR Interventions in a General Hospital Psychiatric Units in India

Possible PSR Interventions in a General Hospital Psychiatric Units in India

Aspectos do funcionamento de uma unidade de internação psiquiátrica de um hospital geral

O objetivo deste trabalho é descrever o funcionamento de uma unidade de internação psiquiátrica (UIP) em um hospital geral em seus aspectos eminentemente práticos. Reunir vários pacientes psiquiátricos graves e manejá-los é uma tarefa desafiadoramente árdua. A farmacologia ainda é empírica e paliativa, a despeito dos grandes esforços e avanços científicos alcançados nos últimos anos. Tentar discutir o embasamento que respalda cientificamente as condutas e manejos dentro de uma UIP poderá lançar luz ao nosso conhecimento, principalmente daqueles que estão iniciando a prática psiquiátrica, sejam estudantes estagiários ou residentes.

Open general medical wards versus specialist psychiatric units for acute psychoses.

As international healthcare policy has moved away from treating people with severe mental illness in large inpatient psychiatric institutions, beds for people with acute psychiatric disorders are being established in specialised psychiatric units in general hospitals. In developing countries, however, limited resources mean that it is not always possible to provide discrete psychiatric units, either in general hospitals or in the community. An alternative model of admission, used in the Caribbean, is to treat the person with acute psychosis in a general hospital ward. To compare the outcomes for people with acute psychoses who have been admitted to open medical wards with those admitted to conventional psychiatric units. The Cochrane Schizophrenia Group's study-based register was searched (November 2001). This register is compiled from searches of BIOSIS, CINAHL, The Cochrane Library, EMBASE, LILACS, MEDLINE, PsycINFO, PSYNDEX, Sociofile, and many conference proceedings. All relevant randomised or quasi-randomised trials, allocating anyone thought to be suffering from an acute psychotic episode to either acute management on general medical wards, or acute management in a specialist psychiatric unit. The primary outcomes of interest were length of stay in hospital and relapse. Studies were reliably selected, assessed for quality, and their data would have been extracted. Homogeneous data were to have been synthesised. For binary data, the risk ratios (RR) and 95% confidence intervals (CI) were to have been calculated on an-intention-to-treat basis. If possible, the number needed to treat/harm statistic (NNT/H) was to have been calculated. For continuous data, weighted mean differences (WMD) were to have been calculated and only data from valid scales would have been reported in this review. We identified no relevant randomised trials. The Caribbean practice of treating people with severe mental illness on general medical wards has been influenced by socio-economic factors rather than evidence from randomised trials. This practice affords an opportunity for a well designed, well conducted and reported randomised trial, now impossible in many other settings.

Psychiatric units in Brazilian general hospitals: a growing philanthropic field.

Some countries, mainly in North America and Europe, have adopted psychiatric wards in the general hospital as an alternative to the classic psychiatric hospital. In Brazil there are 6,169 general hospitals, 1.3% of which with a psychiatric unit. This service strategy is scarcely developed in the country and comprises only 4% of all psychiatric admissions. There was no information on the facilities and functioning of the psychiatric units in general hospitals. To determine the main characteristics of psychiatric units in Brazilian general hospitals and to assess the current trends in the services provided. A mailing survey assessed all 94 Brazilian general hospitals which made psychiatric admissions. A two-page questionnaire was designed to determine the main characteristics of each institution and of the psychiatric unit. Seventy-nine (84%) questionnaires were returned. In contrast to the 1970s and 1980s, in the last decade the installation of psychiatric units has spread to smaller philanthropic institutions that are not linked to medical schools. A fifth of hospitals admit psychiatric patients to medical wards because there is no specialist psychiatric ward. They try to meet all the local emergency demands, usually alcohol-dependent patients who need short term admission. This could signal the beginning of a program through which mental health professionals may become an integral part of general health services. The inauguration of psychiatric wards in philanthropic hospitals, as well as the admission of psychiatric patients in their medical wards, is a phenomenon peculiar to this decade. The installation of psychiatric services in these and other general hospitals would overcome two of major difficulties encountered: prejudice and a lack of financial resources.

APA Proposes Adoption of New Medicare Payment Model

APA Proposes Adoption of New Medicare Payment Model

Psychiatric reform in Germany.

To describe the ongoing process of German psychiatric reform and the structure and functioning of mental health services. Information sources used include official reports describing mental health services, relevant publications related to organization and functioning of services. There has been far-reaching change in mental health care since the late 1960s: psychiatric hospitals have lost about 50% of their beds and one psychiatric hospital has been closed. One hundred and sixty-five general hospital psychiatric units have been built up. Out-patient, community and residential services have been developed. There is a lack of diversified residential and rehabilitation services, particularly for the most severely ill. Co-ordination of care is not always ensured, transfer of patients to remote nursing homes has occurred in some places. Carers and service users articulate their views to an increasing degree. Political and professional enthusiasm have been important in implementation of the German reform. Evolving it further will require major efforts.