Psychiatric hospital care in America has evolved significantly since its inception in the early 1700s. According to the U.S. National Library of Medicine, early care for mental illness began in the basement of the Pennsylvania Hospital, organized by the Quakers of Philadelphia. During this time, mental illness was considered as afflictions of moral failing that deserved punishment. The initial accommodations offered in subsequent hospitals during the 1800s included being confined and shackled to the walls of small concrete rooms. Penn Medicine explains that overcrowding and the belief of mental illness as incurable prompted a revolution of sorts in physicians that believed mental conditions were worthy of different treatment. Modern psychiatric hospitals still house people with mental illness; however, the length of stay is far shorter and myriad treatment services are provided by trained staff.
Population Served
According to MayoClinic.com, over 200 valid mental health conditions exist, ranging from mild to severe. People experiencing significant distress in life that reduces the ability to function on a daily basis because of symptoms associated with any one of the possible mental illness diagnoses are served by psychiatric hospitals. Many psychiatric facilities serve differing age groups and have secluded units for juveniles, adults and the geriatric population. In some cases, stand-alone facilities serving one age group exist, which is typical in the case of children and juveniles with mental health conditions.
Crisis Stabilization
Crisis stabilization refers to emergency care for the psychiatric patient. Hospital.com explains that this portion of the psychiatric hospital is dedicated to receiving and treating acute states of violence, suicidal behavior or psychosis. In some instances, the patient is brought to the crisis stabilization unit involuntarily by police or emergency services because the patient posed a threat to himself or others. Depending on the state laws, the patient is held for observation involuntarily and a judge may order continued treatment or deem the patient ready for release. In the event the patient in crisis is brought voluntarily, the crisis stabilization unit assesses the symptoms reported by the patient then refers the patient for further care based on need.
Residential Care
In the event of the patient requiring ongoing stabilization, psychiatric hospitals have medium-term and long-term care units. Hospital.com indicates that the medium-term units serve the purpose of stabilizing the patient on medications, which often takes weeks to achieve therapeutic effect. The patient is evaluated prior to beginning medication, after a few weeks on medication and before discharge to determine if the medication treatment alleviated problematic symptoms. Long-term care, once the crux of early psychiatric hospitals, is still an option in 2010. However, long-term care is used in the most extreme situations where the community would be at risk if the patient were released too soon. A 2001 study in "Psychiatric Services" explains that a small number of patients require long-term care and comprise those with significant histories of violence, requiring a secure unit with close supervision.
Staff
Psychiatric hospitals have treatment teams comprised of trained staff that provide specific services to the individual needs of the patients. MayoClinic.com notes that a treatment team may include the psychiatrist, psychiatrist nurses and social workers. The primary function of the psychiatrist is to evaluate, diagnose and treat the presenting symptoms through medication or psychiatric testing. Psychiatric nurses provide daily medications to the patients and maintain checks on vital signs and the health aspects of patient care. Social workers serve the role of providing support, counseling and engage the patient in therapeutic activities during the hospital stay.
Treatment Provided
Treatment during crisis stabilization is acute and involves diagnosing the initial symptoms. Typically, medications are the intervention of choice. Patients staying in the hospital longer than two days are given the option of attending group therapy and individual counseling. MayoClinic.com explains that combination treatment includes medication stabilization, psychotherapy to explore the symptoms of mental illness and ways to better manage stress. In some hospitals, electroconvulsive therapy is still offered. This involves sending electrical currents to the brain to change brain chemistry and reduce the problematic symptoms.
Discharge Plans
Discharge planning occurs for patients deemed ready to leave the psychiatric hospital and return to the community. During discharge planning, the treatment team speaks to the patient about housing arrangements and transportation and sets up outpatient community care. This is an important step in the process of continuing care for the patient because the more support the patient utilizes while in the community, the less likely the patient will require emergency psychiatric care and hospitalization. The 2001 study in "Psychiatric Services" emphasizes the importance of community care in successful outcomes for managing mental illness outside of the psychiatric hospital setting.
Financial Aspects
Cost for psychiatric hospitalization differs depending on the facility. Most insurance companies cover short-term residential stays. Medicaid and Medicare are accepted in most psychiatric hospitals. Patients deemed an apparent threat to themselves or others who are unable to pay for care cannot be turned away from psychiatric hospitals. However, the patient will get a bill for care once discharged. Some state psychiatric hospitals have grant funding to care for patients without insurance.
References
- Hospital.com: Choosing a Long-Term Psychiatric Hospital
- "Psychiatric Services": Long-Stay Patients in State Psychiatrci Hospitals at the End of the 20th Century
- U.S. National Library of Medicine: Diseases of the Mind
- MayoClinic.com: Mental illness: Treatment and drugs
- Penn Medicine: Pennsylvania Hospital's Influence on the Field of Psychiatry
