Impediments to the discharge planning effort for psychiatric inpatients.

OBJECTIVE: This study investigates a methodology to systematically track the effort to overcome impediments to securing needed post-hospital care and support. METHODS: 494 consecutive admissions to the Mount Sinai Medical Center were evaluated for the quality of available support resources in the domains of housing, daily activity, and psychiatric treatment using the Mount Sinai Discharge Planning Inventory. On day seven, the same rater recorded the optimal discharge plan for each resource category and those impediment codes that were likely to interfere with attaining the desired resource. On discharge, the rater recorded the actual resources obtained for the patient, and if the plan did not meet the patient's needs, an impediment code was used to explain why the sub-optimal "discharge fit" was not secured. RESULTS: Having an impediment in any of the three resource categories (housing, daily activities, psychiatric treatment services) at day 7 was predictive of a sub-optimal discharge plan. Of all three resource categories studied, a decline in overall impediments from day 7 to discharge was significant only for psychiatric treatment services. An internal/clinical impediment in any of the three resource categories on day 7 was associated with a patient history of alcohol and drug abuse. A significant association was found between having external/environmental impediments identified at discharge for housing and psychiatric treatment services with return to the hospital within 90 days of discharge. CONCLUSION: Study of the impediments to the discharge planning effort provides an opportunity to elucidate the factors that comprise the pathway of recovery from psychiatric illness, but which are normally ill-defined, poorly understood, or not readily measured.

Influences on fit between psychiatric patients' psychosocial needs and their hospital discharge plan.

OBJECTIVE: The study examined factors that help determine a good or poor fit between the psychosocial support needs of hospitalized patients and the hospital's discharge plan. METHODS: The Mount Sinai Discharge Planning Inventory was completed weekly for 494 consecutive admissions to the hospital's adult inpatient psychiatric units. The resources that patients brought with them into the hospitalization in the areas of housing, entitlements, daily activities, and psychiatric treatment were recorded as well as the resources that would constitute an optimal discharge plan. Good or poor fit was operationally defined by the match between the optimal, first-choice plan and the implemented discharge plan. RESULTS: One-third of admissions were found to have an optimal fit on admission in all resource categories studied. For patients who entered the hospital with suboptimal resources, discharge planing was significantly more likely to establish clinically relevant psychiatric treatment options and to strengthen daily living activities than to change housing resources. Certain diagnoses and a history of drug abuse, criminality, violence, and treatment noncompliance were associated with poorer fits with first-choice disposition options. CONCLUSIONS: The Mount Sinai Discharge Planning Inventory provides a method to systematically evaluate discharge planning by tracking progress toward securing relevant posthospital care and support.

The roles of social work in psycho-biological research.

Social Workers have an opportunity to utilize their skills in the arena of psychiatric research. Traditional areas of social work functions, including working with patients, families, groups, complicated systems, and interdisciplinary teams, as advocate, therapist, mediator, and manager, are all necessary for the successful implementation of psychiatric research projects with human subjects. The repertoire of social work skills can enhance the successful operation of research involving bio-psycho-pharmacological or neurobiological trials.

Family understanding of psychiatric illness.

Family members of patients with a diagnosis of schizophrenia were surveyed to ascertain their understanding of their relative's illness. This paper reports on deficits in knowledge of family members as they struggle to absorb the repercussions of chronic illness. It was useful for the development of a psycho-education treatment curriculum while dramatically demonstrating the need for it.

Telling the diagnosis: implications for social work practice.

If families are to provide de-institutionalized psychiatric patients with primary care in the community, it is necessary to provide them with the skills, background and motivation to deal with the multitude of problems that chronic mental patients present. Families do best when they have a sense of cognitive mastery about all aspects of the family member's illness, but not all practitioners are comfortable about discussing or revealing such information. This paper surveys the attitude of social workers, psychologists and psychiatrists as it applies to utilizing the diagnosis in treatment.