The treatment of involuntary patients in the general hospital psychiatric unit

In response to pressure to assume more responsibility for chronic patients, many general hospitals have asserted that they should limit care to those suitable for voluntary treatment on an open ward. This assertion appears to be based primarily on political and symbolic arguments. The limitation of admission to voluntary patients would serve to exclude many acutely psychotic patients with excellent prognosis best treated in a general hospital. The locked ward appears to offer the maximum flexibility in dealing with illnesses which in varying degrees affect the individual's judgement and impulsivity. The limitation of psychiatric units to voluntary patients in open wards would preclude psychiatry from joining in the mission of the general hospital—the best possible care for the community it serves.     

Increase in involuntary psychiatric admissions of minors

Abstract. Objective: The aim of this study was to assess the frequency and trend over time of involuntary psychiatric admissions of minors, and to examine the psychiatric diagnoses in involuntary admissions of minors as compared to those admitted on a voluntary basis. Method: A retrospective register study was made during the period 1996–2000 of a nationally representative hospital discharge register in Finland. Results: Involuntary admissions of children (aged < 12) and adolescents (aged 12–17) increased vastly over the study period, both in absolute figures and in proportion to all admissions in the age groups. Although some disorders were more likely to be linked to compulsory admission than others, a variety of individual diagnoses were represented under compulsory admission. Conclusion: More comprehensive guidance for clinicians is needed regarding the involuntary admission of minors. More theoretical and empirical research is needed on minors competence to consent to or refuse treatment.     

A general hospital psychiatric unit inpatient facility

Summary Patients admitted to the inpatient ward of a psychiatric unit in a general hospital have been studied with regard to their clinical characteristics, reasons for admission and discharge patterns. The results indicate that patients are most often admitted for the management of acute disturbance and detailed diagnostic evaluation and they are discharged in a semi-improved state. Implications of such a service pattern are discussed.     

How to improve clinical practice on involuntary hospital admissions of psychiatric patients: Suggestions from the EUNOMIA study

Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients’ rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.     

Admissions to a South African general hospital psychiatric unit

In a study of adminssions to the psychiatric unit of a general hospital from December 1, 1977, to November 30, 1978, data obtained from all 478 admitted patients were analyzed; the most prevalent condition was found to be the neuroses, followed by organic brain syndromes. Most patients admitted fell into the 19–39 age group, with a preponderance of male admissions between the ages of 6–39, but more admissions of females above 40. A significant difference in the occurrence of conditions between the sexes was noted: the most prevalent condition for males between the ages of 6–39 years was schizophrenia, while more females suffered from the neuroses. Males 40 years and older presented predominantly with organic brain syndromes; females in that age group presented predominantly with affective psychoses. The average length of stay for both sexes was eight days. Schizophrenia required the longest hospital stay, an average of 11 days. Seventy-eight patients (16.3%) were admitted more than once during the period of study. Conditions commonly associated with readmission were affective psychoses and schizophrenia. The role of the general hospital psychiatric unit and its advantages and shortcomings are discussed.     

Medical and surgical consultations to a general hospital psychiatric unit

This study reviews 563 medical and surgical consultations to a general hospital psychiatric unit over three years. In addition to an analysis of the consultations by service and month, consulted patients are compared with nonconsulted patients by age, sex, and diagnosis. Parallels are drawn to psychiatric consultations as reported in the consultation-liaison literature to medical and surgical patients. Two important findings from the present study are that depressed patients received significantly (P < 0.01) fewer consultations than expected, and that 49% of one year's consultations were for active medical problems not related to the reason for psychiatric admission.     

Length of stay in a general hospital psychiatric unit

Fifty psychiatric inpatients with a prolonged length of stay were compared to 50 control admissions for factors associated with prolonged hospitalizations in a general hospital. Seven variables were found to be significantly overrepresented among the long stayers, including treatment with electroconvulsive therapy, medical consultations, underemployment, dementia, disposition to a place other than home, absence of alcohol or drug abuse, and presence of psychosis without affective symptoms. The clinical and policy implications of these finding are discussed.     

The psychiatric acute observation unit in a general hospital

A general hospital based psychiatric acute observation and treatment unit is described, and its operation over a one year period is reviewed. This seven-bed unit is designed to provide constant nursing observation and management, as well as intensive psychiatric treatment, in a secure, safe, and quiet environment for the most acutely psychiatrically ill patients. During the year under review, the unit had 330 admissions. Demographic, clinical, and treatment data are presented, and management of disturbed behavior, staff selection, and acceptance of the unit are discussed.     

The uses of seclusion on a general hospital psychiatric unit.

Seclusion was used in the management of 36.6% of the patients on a general hospital psychiatric unit during a 6 month prospective study. It was initiated most frequently to decrease stimulation for agitated patients with poor impulse control, between 10 pm and 2 am, and when the unit census was high. Patients who required seclusion were significantly younger, hospitalized longer, more often manic and received pharmacotherapy more frequently. No correlation was found between nursing staff age and psychiatric experience and the frequency that they initiated seclusion. The value of seclusion during a medication-free diagnostic assessment period is discussed.     

Effects of a smoking ban on a general hospital psychiatric unit

On January 1, 1987, the Board of Trustees of Southwest Washington Hospitals instituted a smoking ban in all of its facilities, including the 17-bed general psychiatry unit. Our study of ward atmosphere, PRN medications, and negative incidents related to that change are reported. We feel the change was introduced successfully with minimal impact on the successful function of our service. Others are encouraged to proceed with validation of our experience.     

The psychiatric inpatient unit in the general hospital: clinical demography

Data from the University of Iowa Psychiatric Hospital are consistent with national trends. Inpatients tend to be young, female, and have psychotic rather than non-psychotic disorders. Women were significantly older than men at admission for most psychiatric disorders. During the past 20 years, length of stay has dropped by over 50%, while admissions have almost trebled and re-admissions doubled. Historic trends are reviewed and clinical implications are discussed.