Health maintenance organizations and their implications for psychiatry.

Rapidly rising health care costs, a growing surplus of physicians, and recent federal legislation have created a more competitive health care market and have led to rapid growth in the number of health maintenance organizations, or HMOs. HMOs may place psychiatrists and their patients at a disadvantage because they generally restrict coverage of mental illness, use mental health practitioners other than psychiatrists, and lack provision for treating chronic and indigent mentally ill patients. In this review article, the authors describe the characteristics of HMOs, review the historical, legislative, and economic forces that have contributed and will contribute to their explosive growth, and outline measures that psychiatrists must take to ensure that mental health care is not compromised in HMOs and other price-competitive health care delivery systems.

Staff response to suicide of hospitalized psychiatric patients.

The authors cite seven case histories of inpatients who committed suicide over a five-year period and analyze staff reaction and the changes in policy and procedures that followed. They conclude that staff feelings of guilt and failure brought about by inhospital suicides may result in the implementation of procedures designed to decrease risk, but that such procedures would not necessarily have prevented the suicide that led to their introduction. They maintain that staff acceptance of total responsibility for preventing suicide may achieve short-term safety at the expense of increased long-term risk, and that suicides can occur even when all reasonable precautions have been taken.

Suicide in the psychiatric hospital.

The authors note that although the psychiatric hospitals is often used as a means of preventing the suicide of disturbed patients, some hospitalized patients succeed in committing suicide; such as an event is distressing for hospital staffs as well as for patients and families. However, the authors believe that the occasional occurrence of in-hospital suicide is inevitable. They present data on the frequency and characteristics of suicides among hospitalized psychiatric patients in Los Angeles County during the period from 1967 to 1972.?23AUTHOR

New methods of psychiatric treatment.

There have recently been many innovations in the field of psychiatric therapy. Many of the new techniques challenge some of the underlying assumptions of conventional psychiatry. Some methods, such as reality therapy and behavior therapy, attack the symptom directly, rather than assuming there is an underlying disorder which must be treated. Another, crisis therapy, stresses brief intervention aimed at rapidly reestablishing previous levels of function, with relatively little concern for insight into developmental causes. Or, as in family therapy, the pattern of family interaction rather than the individual may be the primary object of study and treatment. Each of the new methods of treatment has certain advantages as well as disadvantages. They have stimulated psychiatry to explore innovative methods and should make it possible eventually to incorporate in the treatment of each individual those techniques which will most effectively meet his needs.