When discussing whether psychiatric admission is needed, one of the most common questions I'm asked in an ER, PES, or CSU is: "Why does it have to be the hospital?" Then later in the day, I'll speak to a different patient who asks, "Why can't I just go to the hospital?"
Answering these questions usually involves pulling up a chair and starting to explain, broadly, that admission to a psychiatric hospital involves working through an emergency psychiatric evaluation and from there making a series of medical justifications.
The decision to admit to a psychiatric hospital is largely centered around the concept of level of care, with hospitalization being the highest level of psychiatric medical care available.
As previously discussed, psychiatric hospital beds are limited, and so many care teams try to admit to them only when absolutely needed to make efficient use of a limited resource.
To provide an inpatient level of care, a psychiatric hospital typically provides:
24/7 access to a psychiatrist
Access to a psychiatric pharmacy, or a pharmacy comfortable with supplying a broader range of medications than is typically available in an ER setting.
Safety protocols that help protect patients who are struggling with maintaining safety on their own
A medical team where each member has mental health training, including the nurses, social workers, and the administrative staff
Staff members and psychiatrists who understand the interface between psychiatry and local laws
Experience transitioning patients from an inpatient level of care to a lower level of care safely and appropriately
When the decision is ultimately made to admit a person to a psychiatric hospital it's because, when considering all the other local care options, no lower level of care would be adequate to move forward with that person's treatment plan.
Increasingly frequently, a patient may also be admitted to a psychiatric hospital because a CSU or PES has attempted to coordinate a lower level of care, and the process proved to be more complex than they are resourced to support. The patient is then transferred to inpatient psychiatry due to the increased resources an actual hospital is able to provide.
Kommentare