Why Not Hospital Care?

Those of us who have been managing and treating psychiatric patients for some time are well aware of the difficulties, restrictions, and short-sidedness imposed by managed care. The less-experienced doctors and those still in training may not be aware of the therapeutic consequences of the current trend in hospital psychiatry.

Compliance with managed care criteria has forced our community hospital staff to justify admissions to the inpatient services if patients show either serious self-destructive (suicidal) or violent (homicidal) acts.

The intensive, comprehensive, therapeutic environment and constructive milieu program provided in an inpatient psychiatric service is intended to protect patients from perpetuating the pathogenic conditions in which they live and so help them find ways for a healthier life. To allow patients to stay with the persistent conditions of the physical and psychiatric traumata unfortunately may cause more prolonged, serious, and harmful consequences and certainly more expense.

Imagine allowing a patient to be subjected to harmful allergens, malnutrition, sources of bacterial infection, or destructive relationships—that would certainly be considered abuse of the patient’s body and mind. By the same token, psychiatric patients who are suffering from severe states of depression, anxiety, misperceptions, delusions, hallucinations, and so on should have the opportunity for intensive therapeutic intervention. As one psychiatric patient who has frequent periods of depression, alcohol abuse, inability to go to work, and staying away from his family, said, “My five-day stay in the hospital was a turning point in my life. I couldn’t have done it any other way. I now know better how to go on.” And, indeed, he continued to function well in his professional position and as a family man.

Should we not be compassionate doctors and allied professionals who care for our patients and their families more effectively and aggressively also in a hospital setting?