Suicide in the psychiatric hospital.

Society's attitudes toward and treatment of the suicider are examined. The emotional and clinical impact suicide has on everyone, and its consequences to the hospital are detailed. Our unfortunate emphasis on "prevention" as against treating the disease process which causes the death is stressed. Also stressed is the psychiatrist's misplaced role in contrast to that of other physicians involved in a patient's death. Only in psychiatry does it seem that the role assigned the physician is that the he prevent a specific patient's death as much as that he treat the patient's underlying fatal disease.

Long-term hospital treatment: a 25-year study.

Findings from a 25-year study of admissions to a single long-term private psychiatric inpatient facility document a sharp decline in average age and an increase in concurrent diagnoses of substance abuse and personality disorders. In this case, long-term private inpatient care has survived the significant changes in mental health policy and funding practices of the past quarter century, but has shifted its focus from a more general psychiatric caseload to the seriously disturbed adolescent or young adult patient. There are numerous factors which determine every aspect of hospital treatment. Though some are easily determined, many are dimly defined and difficult to measure. At present, their effect on patient progress is obscure. These factors, discussed in some detail, may be internal and peculiar to an institution itself. A dialogue is initiated for the insight it furnishes about the changes that have occurred in hospital treatment.

The long-term hospital treatment of the young chronic patient: follow-up findings.

A follow-up of sixty young-adult psychiatric patients hospitalized at least six months revealed that, at one to three years post-discharge, 83 percent were living in the community. Nearly two-thirds of the 60 patients were actively involved in aftercare treatment. A method of categorizing outcome based on overall level of functioning revealed that good outcomes occurred even among patients whose prognoses, based on treatment history and diagnosis, might be considered guarded. Findings are discussed in relation to the need for information on the efficacy of long-term psychiatric inpatient treatment and the identification of patients who might benefit from this form of care.

Nicotine addiction in the psychiatric hospital: final report.

The following facts are now accepted by everyone with any sense of objectivity. One, that there is an entity known as nicotine addiction and that smoking is such an addiction. Two, that this addiction is related to more preventable deaths than any other disease in the United States. Three, that smoking now causes more deaths from lung cancer among women than does breast cancer. Four, that smoking interferes with the metabolism of the very drugs we use in psychiatry to alleviate symptoms. Five, that smoking is more common among psychiatric patients than in the general population, and more so among the hospitalized mentally ill. This paper, the third in a series, covers the problems encountered in bringing smoking to a complete halt within a psychiatric hospital. It deals with the emotional reactions professional staff had in confronting the problems anticipated and following the results of the effort. It further describes the results which ensued with patients over a one and a half-year period.

Young chronic patients and substance abuse.

The prevalence of substance abuse was investigated in 100 young chronic patients consecutively admitted to a long-term private psychiatric hospital. Data were obtained from diagnostic research interviews with each subject at admission. Half of the subjects had concurrent diagnoses of psychiatric disorder and substance abuse. One-third of the dual-diagnosis patients began using substances before the onset of a diagnosable psychiatric disorder, and they more often had a diagnosis of schizophrenia. Half of the dual-diagnosis patients abused three or more drugs. Implications of the findings for treatment and community management of dual-diagnosis patients are discussed.

Cultural aspects of the psychiatric hospital.

How a psychiatric hospital may be viewed will depend on how its professionals think about the origins and treatment of the mental disorders. If the illness is considered physical in origin, the hospital dealing with it will give medications and apply physical methods of therapy with the aim of discharging the patient rapidly. If one regards the mental disorder as having social origins the institution will deal with its social factors as important to the therapeutic process. It will design itself as a therapeutic community and consider itself primarily as such. The physical aspects of treatment will be thought of as secondary to the social ones. One may think of a psychiatric hospital as a particular type of society or culture. In this culture the patient and staff are immersed and interact in the therapeutic process. It is to this culture that the patient must adapt. It is in this culture that physical treatments and social factors are brought to bear on the patient. This culture must in turn impact on the patient for better or worse. This view requires a study of the elements which make the hospital's culture. It needs a knowledge of the larger culture and an awareness of its own impact on the institution. The value-system of the hospital also has a place of importance. This paper deals with the above and elements important to a psychiatric hospital which views itself as a culture.

Commentary: coping with nicotine addiction in the psychiatric hospital.

Smoking is an all too common practice. Mounting evidence compels us to see it as an addiction rather than the habit we have conveniently called it. The injurious effect smoking has on the health and life span of hundreds of thousands of people annually is unquestioned. The negative effect nicotine has on the metabolism of medications we commonly use in psychiatry is becoming increasingly known. The call by the American Medical Association to ban all advertising of tobacco also compels our attention as physicians. This paper deals with these matters, and describes the issues considered as well as the preliminary measures taken in a psychiatric hospital to combat nicotine addiction.

A review of issues surrounding length of psychiatric hospitalization.

Recent emphasis on cutting the costs of psychiatric care and the possibility that reimbursement for psychiatric services will one day be based on diagnosis-related groups has stimulated debate about the proper length of psychiatric hospitalization. The authors review the literature on length of stay, focusing primarily on studies of the relationship between various patient and environmental variables and length of stay and studies comparing the outcomes of long and short hospitalizations. They conclude that diagnosis alone is not an accurate predictor of length of stay but may have predictive ability when combined with other data. Most studies found no differences in the outcomes of short and long hospitalizations. The authors identify numerous avenues for further research and are optimistic that a policy governing length of stay is within reach.

Toward the ideal state mental hospital: the human equation.

This paper gives the historical sketch necessary for an understanding of the current state of American psychiatry. It reviews some of the reasons why the rendering of good hospital care must be reconsidered, and describes some of the main features of the future public institution.

The socially-oriented psychiatric hospital.

The programs of psychiatric hospitals illustrate the differences we have about the origins and treatment of mental illness. They reflect the conflicts which divide us into camps. Most hospitals today are biologically oriented and their programs are short-term in nature. They mainly understand mental illness to be physical in origin and emphasize the physical and physiologic in their treatment approach. Fewer hospitals are socially-oriented. This paper deals with the socially-oriented hospital. It briefly discusses their theoretical frameworks and touches upon significant contributions to the literature. Main attention is given to one particular type of such institution. Its structure is described as it is used to satisfy its patients' needs and to generate healthy behavior in them. The way it treats its patients and the use to which it puts its own value-system in the treatment process are outlined.

Future of the chronic schizophrenic patient: prediction and recommendations.

A glimpse into the future for the schizophrenic patient requires a grasp of the history of American psychiatry and the many factors which led to the deinstitutionalization process and its negative effects. The paper reviews this material in some depth. It covers in detail the past forty years of legislation which saw psychiatry rise to heights of good care and then slowly decline to its present state. Some predictions are made about the continuing fate of the state system, how schizophrenic patients are likely to be viewed and treated, and where they will tend to live. Long-term psychotherapy increasingly will fall into disrepute, hospital care will be increasingly brief, biologic in its emphasis and the numbers of chronically ill schizophrenics will grow out of control. It is predicted that there will not be a breakthrough in either the biologic or social fields, and pessimism will reign.

Build a better state hospital: deinstitutionalization has failed.

The author cites increasing numbers of chronic, homeless, and neglected mentally ill people as evidence of the failure of deinstitutionalization and community care to live up to their promise to reduce chronicity, the need for long-term hospitalization, and even mental illness itself. He believes the state hospital system, despite having been maligned and nearly destroyed, has great therapeutic potential. It could provide extended care to acutely ill patients before they become chronically ill; restore the ability to pinpoint responsibility for patient care, which has been lost under community care; and provide a stimulating academic environment conducive to research into treatment of the mentally ill.