Private Psychiatric Facility Research Articles

Cultural perspectives and experiences of mental healthcare in Kwa-Zulu Natal, South Africa

Background: Healthcare systems reflect worldviews, specifically in mental health, where norms dictate what is normal and abnormal. The era of coloniality promoted Western dogma over collectivist cultures, which were marginalised. This study explored the perspectives and experiences of Black, isiZulu-speaking, South Africans who utilised multidisciplinary services, based on a Western-based therapy model at a private psychiatric facility in KwaZulu Natal. Methods: A qualitative descriptive design was utilised. Purposive sampling was utilised to recruit 10 participants. Data was collected through semi-structured interviews. Braun and Clarke’s six phases of thematic analysis were used to guide the data analysis. Findings: Three themes with sub-themes emerged from the data: personal perceptions, which explored how isiZulu-speaking people made sense of mental health and mental illnesses. Cultural perceptions were the collectivist method of problem-solving, which stressed the importance of spiritual beliefs. Health-seeking behaviour considered the experience of the isiZulu-speaking mental health care user. Cognitive dissonance prevailed due to the difference between westernised mental health treatment and traditional healing systems. Conclusion: The family and community are intertwined in participation, reputation, and healing. There is an emphasis on enduring hardship and following traditions, which are preserved by valued elders. Disregarding these norms can outcast the Zulu individual who strives toward inclusion within the community. Implications for practice: Intervention cannot only be at individual level but also community level. Including the family in psychoeducation and therapeutic goal settingwould be beneficial to the Zulu MHCU. Group programmes should address gender-specific issues. Occupational therapists must recognise the importance of participating in spirituality for the healing of the Zulu MHCU and appropriately include it in intervention. Mental health resources and awareness programmes need to be disseminated atcommunity level. Competency in the isiZulu language is recommended.

Repetitive transcranial magnetic stimulation: Course and early prediction of response in depression

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression, yet few studies have mapped the trajectories of symptom change over treatment. Tracking clinical response during early treatment may be helpful to predict outcome, particularly non-response. MethodsWe used naturalistic data (N = 117) to examine changes in the Daily Symptom Index (DI-5) scores of adult patients with unipolar or bipolar depression who underwent ≥16 treatment sessions of left dorsolateral prefrontal cortex rTMS at a private psychiatric facility in Western Australia, between 2016 and 2019. ResultsTwo response trajectories were charted: non-response (N = 71, 61%) and response (N = 46, 39%). Both trajectories diverged at 99% confidence interval at session 10, which was used as the point to predict treatment response at session 20. The response group showed a reduction of 4.21 in the mean DI-5 score from baseline at session 10. On this basis, a 4-point reduction in the DI-5 score at session 10 was defined as predictor of responder status at session 20. If the improvement is < 4 points at session 10, the probability of non-response at session 20 is 75%. If the improvement is ≥ 4 points, the probability of response at session 20 is 66%. LimitationsThe DI-5 scores were not examined beyond 20 treatment sessions, which may have shown delayed responders in the non-response group. ConclusionsIn this study of depression response trajectories with rTMS treatment, prediction of response at session 20 can be made at session 10 of treatment. Further research is required to generalise the current findings.

Psychiatric Patient Length of Stay in the Emergency Department Following Closure of a Public Psychiatric Hospital

BackgroundPsychiatric patient boarding in the emergency department (ED) is a ubiquitous problem associated with increased morbidity and mortality. ObjectiveWe evaluate the effect of closing a public psychiatric facility in a major metropolitan area on the ED length of stay (LOS) of psychiatric patients. MethodsThis was a retrospective chart review at two metropolitan EDs of all patients assessed to require inpatient psychiatric hospitalization. The time of arrival, time of disposition, time of transfer, insurance status, and accepting facility type were collected prior to and following the closure of a local inpatient psychiatric facility. ResultsWe analyzed a total of 1107 patients requiring inpatient psychiatric hospitalization, with 671 patients who presented prior to the closure of the closest public psychiatric facility and 436 patients that presented following the facility closure. Following hospital closure, patients with private insurance (620 min before, 771 min after) and Medicare/Medicaid (642 min before, 718 min after) had statistically significantly longer ED LOS, as well as patients transferred to a private psychiatric hospital (664 min prior, 745 min after). However, overall ED length of stay following hospital closure for transfer of all psychiatric patients requiring inpatient hospitalization was not found to be statistically significant (1017 min prior, 967 min after). ConclusionThere was a statistically significant increase in ED LOS for patients with private insurance, Medicare/Medicaid, and for those patients transferred to a private psychiatric facility following closure of a public mental health hospital; however, overall, ED LOS was not increased for patients transferred to an inpatient psychiatric facility. This study highlights the significant impact that the closure of a single inpatient psychiatric facility can have on nearby EDs. We hope to bring attention to the need for increased psychiatric services during a time when there is a nationwide trend toward the reduction of available inpatient psychiatric beds.

Patterns of dissociative (conversion) disorder cases in private psychiatric facility and the effectiveness of an indigene model of psychotherapy

This is descriptive study was carried out on newly diagnosed dissociative (conversion) disorder patients admitted in private health care facility, Iftikhar Psychiatric Hospital Peshawar.The studied was carried out from January 2012 to December 2012. Cases were diagnosed according to international classification of disease (ICD-10) diagnostic criteria. Subjects were selected through purposive sampling. A total of 139 patients were included in this study. Patterns of and disorder and demographic will be presented in presentation.Due to sociocultural sensitivity of applying dialectical and CBT an indigenes model of psychotherapy was applied.Stage 1: admission of conversion disorder cases for four days admission with informed consent, supportive psychotherapy, and brief psycho-education of attendants to avoid reinforcement of the patient's behavior. Parental single dose medication to break the cycle of fits.Stage 2: it involves exploratory session with the patient and her/his family members focusing on what is the problem with the patient nature of stressors, and the family environment. Meanwhile, we involve the patient in the recreational and occupational therapy to avoid sick role and illness behavior.Stage 3: psychotherapy session with the patient to give psycho-education and insight of her/his mental problem. Discussing different options, and facilitating the patient to come up with the best possible desirable option. Psychotherapy of the family members involved psycho-education about the patient's mental illness, its association with the prevailing stressors, and avoiding reinforcement. Responses have been 85% improvement in conversion disorder, 90% in sensory symptoms, 98% in motor symptoms, 95% in mixed symptoms.Disclosure of interestThe author has not supplied his declaration of competing interest.

Medical Co-morbidities Among Patients with Severe Mental Illnesses in a Community Health Facility in Nigeria.

To examine prevalence of medical comorbidity (MCM) in schizophrenia (n = 1310) and in bipolar disorder (n = 1307) and the association of high burden of MCM (≥3 MCM) with duration of untreated illness, number of episodes, functioning, poly-medication and lifetime hospitalization for the mental disorder. Participants were recruited from a private psychiatric facility in Ibadan, Nigeria between 2004 and 2013 and enquiry made about the lifetime occurrence of 20 common chronic diseases including common tropical diseases. Psychiatric diagnosis was made using the Structured Clinical Interview for DSM IV Axis I disorder (SCID). Except for nutritional anemia, dermatitis and intestinal Helminthiasis, patients with schizophrenia were not at higher odds of reporting MCM than those with bipolar disorder. DUI ≥2 years, episodes of illness ≥3, being on multiple neuroleptics and history of previous hospitalization were significantly associated with high burden of MCM in schizophrenia and episodes of illness ≥3, reduced functioning and history of previous hospitalization with bipolar disorder. Schizophrenia and bipolar disorder are associated with high rates of medical comorbidity. Treatment of this medical comorbidity is essential in order to improve the outcomes for patients with bipolar disorder and schizophrenia.

The influence of individual, group, and relative self-esteem on outcome for patients undergoing group cognitive-behavioural therapy treatment

Despite a strong association between individual self-esteem and treatment outcome in group cognitive-behavioural therapy (GCBT), no study has investigated how patient outcomes might be influenced by an individual's self-esteem relative to other group members. The study comprised a retrospective examination of patients' data and used a multiple regression analysis to identify predictors of treatment outcome. Patients' pre-treatment self-esteem scores were assessed on a continuum and assigned to be low, medium, or high. Therapy groups were assigned to be either low, balanced or high self-esteem groups based on averaged self-esteem scores of participants. In this study, 3,878 patients who had completed a 10-day intensive cognitive behavioural group therapy programme at a private psychiatric facility were included in the study. The Rosenberg Self-Esteem measure was chosen to assess self-esteem. The three subscales of the Depression Anxiety Stress Scales were used as the outcome measures. Patient outcomes were influenced by pre-treatment self-esteem scores, such that higher initial self-esteem was associated with better treatment outcomes. Low group self-esteem was predictive of significantly better outcomes for depression, relative to higher self-esteem groups. Additionally, the combined influence of high individual self-esteem and low group self-esteem was associated with significantly enhanced depression improvement. High self-esteem patients perform better on outcome measures following completion of GCBT. Low self-esteem groups show greater improvement in depression symptoms. Similar results for depression are achieved when patients with high self-esteem complete treatment in low self-esteem groups.

Correlates and antecedents of hospital admission for attempted suicide: a nationwide survey in Italy

The present study examined data on symptom patterns in the week prior to admission for suicide attempt, in a nationwide representative sample of patients. Socio-demographic, clinical, and treatment data was gathered for 1,547 patients admitted over a 12-day index period during the year 2004 to 130 public and 36 private psychiatric facilities in Italy. Patients were evaluated in terms of whether they had been admitted for having attempted suicide or not. A detailed checklist was used to assess symptom pattern at admission; diagnoses were based on ICD-10 categories. Two-hundred thirty patients (14.8%) in the sample had been admitted for suicide attempt. Patients with depression or with personality disorders were more frequently observed among suicide attempters. First-contact patients were significantly more likely to have been admitted after a suicide attempt, the only exception being individuals with bipolar disorder, manic phase. No diagnosis was statistically related to admission after suicide attempt, once symptoms pattern at admission had been accounted for. Disordered eating behavior, depressive symptoms, substance abuse, and non-prescribed medication abuse were positively related to attempted suicide, as were any traumatic events in the week prior to admission; symptoms of psychosis (hallucinations/delusions) and lack of self-care were negatively associated with suicide attempt admission. Greater attention to symptoms immediately preceding or concomitant with admission after a suicide attempt can be a key factor in establishing the best treatment plan and discharge strategy, the most effective community-service referral, and targeted intervention programmes for patients hospitalized for a suicide attempt.

Monitoring treatment response and outcomes using the World Health Organization's Wellbeing Index in psychiatric care

Background Effective psychiatric care requires reliable measurement of patient progress and outcome. The current study aimed to assess the clinical validity of the WHO Wellbeing Index (WHO-5; Bech, P., Gudex, C., Johansen, K.S., 1996. The WHO (Ten) Wellbeing Index: validation in diabetes. Psychotherapy and Psychosomatics 65, 183–190.) for use as a measure of individual treatment response and outcome in mental health care. Method Three hundred and eighteen consecutive inpatients and day patients at an Australian private psychiatric facility completed the WHO-5, SF-36 and DASS-21 routinely during treatment, and 152 undergraduate students completed the WH0-5. Results The WHO-5 was shown to be a measure with high reliability, validity and sensitivity to change, for use with patients who have affective or neurotic primary diagnoses. Further to this, regression analyses demonstrated that early scores on the measure predicted final outcome. Criteria for clinically significant recovery are also presented. Limitations The results may be generalized to samples with primary diagnoses of affective and anxiety disorders. Assessment of the WHO-5 as a measure of treatment response is warranted in other patient samples. Conclusions The current findings illustrate the potential of the WHO-5 as a quick, reliable and valid means for assessing patient outcome and monitoring patient response to treatment in psychiatric services.

First episode psychosis and the trail to secondary care: help-seeking and health-system delays

People experience delays in receiving effective treatment for many illnesses including psychosis. These delays have adverse consequences in heart disease and cancer, and their causes have been the subject of much research but only in recent years have pathways to care in psychosis received such attention. We sought to establish if, when and where people seek help in the early phase of psychosis in a representative sample. One hundred and sixty-five people with first episode psychosis, referred from community-based psychiatric services and a private psychiatric facility to an early intervention service over 18 months, were interviewed with the Structured Clinical Interview for DSM-IV diagnoses. Symptoms were measured using the Schedule for the Assessment of Positive Symptoms, Schedule for the Assessment of Negative Symptoms and the Calgary Scale. Duration of untreated illness (DUI) and duration of untreated psychosis (DUP) were established using the Beiser Scale. Pathways to mental health services were systematically detailed through interviews with patients and their families. The final sample consisted of 142 (88M, 54F) cases after those with psychosis due to a general medical condition and those without pathway and DUP data were excluded. Less than half of participants initiated help seeking themselves. Of those who did seek help (n = 57) 25% did so during the DUI. Those who had a positive family history of mental illness and poorer premorbid adjustment were significantly less likely to seek help for themselves and those who did not seek help were more likely to require hospitalisation. Families were involved in help seeking for 50% of cases and in 1/3 of cases did so without the affected individual participating in the contact. Being younger and having more negative symptoms were associated with having one's family involved in help seeking. Delays to effective treatment from the onset of psychosis were evenly split between "help-seeking delays" and "health-system delays". Having a family member involved in help seeking and better premorbid adjustment were independently associated with shorter help-seeking delays when measured from the onset of psychosis. Being female, having better premorbid adjustment and fewer negative symptoms were associated with shorter help-seeking delays from the onset of illness. Those with a non-affective psychosis had significantly longer system delays. Many people with first episode psychosis do not initiate help-seeking for themselves particularly those with a relative affected by mental illness. Those with poor premorbid adjustment are at particular risk of longer delays. Poor premorbid adjustment compounded by long delays to effective treatment reduces the likelihood of a good outcome. Families play a vital role in hastening receipt of effective treatment.

Legal Barriers, Bias Complicate Aging for Gays, Lesbians

Legal Barriers, Bias Complicate Aging for Gays, Lesbians

Best Practices: Increased Attendance in Inpatient Group Psychotherapy Improves Patient Outcomes

This column describes an initiative that promoted increased attendance in group psychotherapy and its effect on patient outcomes. Information on patient- and staff-rated outcomes, readmission rates, and patient satisfaction was gathered for 2,782 inpatients in a private psychiatric facility in Australia. On average, after the initiative was implemented, patients went from attending one session per day to two sessions. Inpatients admitted after implementation had better patient- and staff-rated outcomes and lower rates of readmission within one month of discharge. However, patients' treatment satisfaction ratings declined. These findings indicate that increasing attendance in group psychotherapy can be a useful adjunct to hospital treatment.

Best Practices: Increased Attendance in Inpatient Group Psychotherapy Improves Patient Outcomes

This column describes an initiative that promoted increased attendance in group psychotherapy and its effect on patient outcomes. Information on patient- and staff-rated outcomes, readmission rates, and patient satisfaction was gathered for 2,782 inpatients in a private psychiatric facility in Australia. On average, after the initiative was implemented, patients went from attending one session per day to two sessions. Inpatients admitted after implementation had better patient- and staff-rated outcomes and lower rates of readmission within one month of discharge. However, patients' treatment satisfaction ratings declined. These findings indicate that increasing attendance in group psychotherapy can be a useful adjunct to hospital treatment.

INJUSTICE AND IRRATIONALITY IN CONTEMPORARY YOUTH POLICY

Lionel Tate was 12 years old when he killed 6‐year‐old Tiffany Eunick. Tiffany had been staying at the Tate home and, by all accounts, got along well with Lionel. The two were playing at “wrestling” when Lionel decided to try out some moves that he had seen on television. He threw Tiffany across the room, inflicting fatal injuries. Despite the boy's tender age, the prosecutor transferred Lionel to criminal court on a charge of first‐degree murder, an offense carrying a mandatory penalty of life without parole. The boy was given an opportunity to plead guilty to second‐degree murder in return for a sentence of three years incarceration, but he rejected the offer. A jury subsequently convicted him of first‐degree murder. At sentencing, the prosecution recommended leniency, which drew an angry response from the judge: If the state believed the boy did not deserve to be sent to prison for life, why hadn't it charged him with a lesser offense? Without any inquiry into the boy's cognitive, emotional, or moral maturity, the judge imposed the mandatory sentence.1Raymond Gardner was 16 years old when he shot and killed 20‐year‐old Mack Robinson.2 Raymond lived in a violent urban neighborhood with his mother, who kept close watch over him. He had no prior record. He was an A student and worked part‐time in a clothing store to earn money for college. On the day of the shooting, a friend came into the store to tell Raymond that Mack had a beef with him about talking to a girl, and was “looking to get him.” The victim was known on the street as “Mack the Knife” because he always carried a small machete and was believed to have stabbed several people. To protect himself on the way home, Raymond took the gun kept under the counter of the shop where he worked. As he neared home, Mack and two other men approached and blocked his path. According to eyewitness testimony, Raymond began shaking, then pulled out the gun and fired. Mack ran into the street and fell. Raymond followed and fired five more shots into the victim's back as he lay dying on the ground. Raymond did not run. He just stood there crying. The prosecutor filed a motion in juvenile court to transfer Raymond on a charge of first‐degree murder. The judge ordered a psychological evaluation, which addressed the boy's family and social background, medical and behavioral history, intelligence, maturity, potential for future violence and prospects for treatment. The judge subsequently denied the transfer motion. He found Raymond delinquent and committed him to a private psychiatric treatment facility.3

Psychiatric residential facilities in Italy. Results of phase I of the PROGRES project

The 'PROGRES' (PROGetto RESidenze' Residential Project) project has 3 aims: 1. To survey all Italian psychiatric Non-Hospital Residential Facilities (NHRF) (Phase 1); 2. To assess in detail 20% of the NHRFs and the patients living there (Phase 2); and 3. To carry on training programmes for the mental health workers of these facilities (Phase 3). We report here the results of Phase 1. All NHRFs were surveyed using a structured interview administered to the manager of the facility. In some cases, this information was supplemented with data gathered from other mental health workers at the NHRFs. On May 31, 2000, there were in Italy 1,370 NHRFs with 17,138 beds, giving an average number of beds per facility of 12.5 and a rate of 2.98 beds per 10,000 inhabitants. This rate varies greatly between regions, with a ratio of 1:10 between the two regions with the lowest and the highest bed rates. Seventy-three percent of the NHRFs have a 24-hour staff coverage; more than 50% are directly managed by the NHS Departments of Mental Health and more than three-quarters of the NHRFs are directly funded by the NHS. In the course of 1999 38% of the NHRFs discharged no patients, and another 32% discharged fewer than 3 patients. In about half of the NHRFs the most common patient age group was 40-59 years. In the Italian NHRFs there are 11,240 full-time mental health workers, plus several thousand half-time staff. The average number of full-time mental health workers in each NHRF is 8.2. In 58% of the NHRFs the operational chief is a psychiatrist; some 40% of the overall number of mental health workers in the NHRFs have no specific psychiatric training. The total number of patients resident in the NHRFs is 15,943; among them, 58% have never been admitted to a mental hospital, 40% have been admitted and a small percentage (1.6%) has been previously admitted to a forensic mental hospital. The availability of NHRF beds is negatively associated with the availability of non-hospital facilities (e.g., community mental health centres, day-centres) and positively associated with the number of beds in private psychiatric facilities in each region. The current rate of NHRF beds in higher than the officially recommended national standard (2/10,000 inhabitants). However, there is a great variability between regions, which is related to the overall provision of different types of psychiatric facilities. Most NHRFs provide intensive care, and the continuum of residential facilities with different types of care, support, degree of autonomy, etc. recommended by several authors for the long-term treatment of severe patients with different disabilities, seem to be lacking. NHRFs have a very low patient turnover rate, and this may create problems in the future. The PROGRES project is the first national study ever carried out in Italy to evaluate a specific type of psychiatric facilities in the context of the new system of psychiatric care. When all the data will be available, it will be possible to assess in detail for the first time a national representative sample of severe, long-stay patients and the care they are receiving; on this basis, it will also be possible to recommend evidence-based policies aimed at improving the care of the severely mentally ill.

Measuring Mental Health Outcomes in a Private Psychiatric Clinic: Health of the Nation Outcome Scales and Medical Outcomes Short Form SF-36

This study reports on data collected from the routine use of the Health of the Nation Outcome Scales (HoNOS) and the Medical Outcomes Short Form (SF-36). Three main aims were addressed in using these measures: (i) to establish patient disability levels; (ii) to determine the level of treatment effectiveness; and (iii) to explore the ability of these instruments to predict length of stay and mood change. The clinician-rate HoNOS and the patient-rated SF-36 were included in the assessment battery, at admission and discharge, of consecutive inpatients (n = 754) at one private psychiatric facility over a 2-year period. The sample, on admission, was comparable in illness severity to levels reported at other Australian private psychiatric facilities. Treatment was shown to be effective, and the degree of changes in HoNOS ratings compared favourably with other private psychiatric facilities. Certain factors underlying the structure of the HoNOS and the SF-36 only weakly predicted length of stay and changes in depression and anxiety levels. The HoNOS and the SF-36 provided valid and reliable data on patient function, with the HoNOS being most sensitive to treatment change. However, neither instrument proved useful in predicting length of stay or levels of depression and anxiety at discharge.

In it for the long haul: the integration of outcomes assessment, clinical services, and management decision-making

Behavioral health providers are increasingly called upon to develop outcomes strategies that highlight opportunities for performance improvement and assess in turn the impact of applying total quality management (TQM) principles to treatment outcomes. This article describes the evolution of an outcomes assessment program at a private psychiatric facility, and presents two case studies of the integration of outcomes data into clinical decision-making. In Study I, outcomes data were used to identify patterns in the responsiveness to treatment of child/adolescent patients with behavioral disorders and document changes in improvement rates following the application of continuous quality improvement (CQI) principles within the inpatient services. In Study II, improvements sought in the outcomes methodology resulted in improved response rates, improved data quality, and new opportunities for both clinical intervention and staff development. Benefits of committing to outcomes assessment over the long haul to facilitate empirically driven planning processes are described.

Caffeine and Nicotine Use in an Addicted Population

ABSTRACT This study was undertaken to examine differences in caffeine and nicotine use between the psychiatric population and the addicted population in a private psychiatric inpatient facility. Eighty-six patients on an adult addictive disease inpatient unit and 80 patients on an adult psychiatry unit in a private psychiatric hospital were interviewed with regard to their use of nicotine and caffeine. In addition, demographic information and primary diagnoses were obtained from the psychiatric admission assessment in the medical record as listed by the admitting psychiatrist. Although there was little difference in psychiatric patients vs. chemically dependent patients with regard to the percentage of caffeine users, the chemically dependent individuals drank more coffee, soft drinks, and tea. A much greater percentage of the chemically dependent individuals also smoked cigarettes, although not in a greater amount than the psychiatric patients who smoked. Because group assignment was not random, ordinary least squares (OLS) regression analyses were conducted to determine the independent associations of age, sex, education, and treatment population in predicting levels of caffeine and tobacco use. Even after controlling for demographic differences between the two samples, chemically dependent patients still reported higher levels of daily caffeine and tobacco use than patients on the general psychiatric unit.

Personality and cognitive functioning among hospitalized sexual offending Roman Catholic priests

A tremendous amount of media attention has been directed towards sexual abuse perpetrated by Roman Catholic priests in recent years. While there are countless research studies on both sexual abuse victims and perpetrators in the professional literature, very few have specifically investigated Roman Catholic priests who sexually abuse minors. The purpose of this study is to investigate the role of personality and cognitive variables among hospitalized sex offending Roman Catholic priests using specific MMPI-2, WAIS-R, and Halstead-Reitan measurements. Specifically, the role of defensive coping styles as measured by the L, K, O-H, and R scales of the MMPI-2 along with IQ scores from the WAIS-R and the Halstead impairment index were investigated. A total of 160 Roman Catholic priests (80 who sexually abused minors and 80 nonabusing control patients) hospitalized in a private psychiatric facility specializing in the diagnosis and treatment of clergy were evaluated. Results suggest that overcontrolled-hostility (O-H) was the most reliable predictor of group membership while Verbal IQ approached statistical significance. Implications for further research are offered.

Private and public psychiatric hospitalization afterZinermon v. Burch

The Supreme Court's decision inZinermon v. Burch left unanswered a number of important questions. This paper discusses the case as it relates to competency to consent to voluntary psychiatric hospitalization, and examines the applicability of theZinermon ruling for private and public psychiatric facilities. The paper also looks at how courts have dealt with competency and voluntariness afterZinermon and the implications of the decision on mental health practice.

Malpractice arising from negligent psychotherapy: ethical, legal, and clinical implications of Osheroff v. Chestnut Lodge.

Traditionally, there have been few legal actions brought against psychotherapists that allege negligent psychotherapy and negligent treatment of psychiatric disorders. However, in the case of Osheroff v. Chestnut Lodge, a patient-physician (Dr. Osheroff) sued Chestnut Lodge, a private psychiatric facility, for negligence based on the staff's decision to apply a psychodynamic model of treatment (through psychotherapy) and not a biological model. The case sparked a heated debate between adherents of the psychodynamic model and those of the biological model. This article explores the implications of the Osheroff litigation for mental health professionals. It is proposed that an interactive informed consent process be used to protect psychotherapists against Osheroff-type litigation.