Dynamics of Institutional Change: The Hospital in Transition

Intended to bridge the gap between inpatient, outpatient, and family-based care, this compendium deals with all aspects of a crisis program, from the first telephone encounter to managing specific types of patients.

Category: Healthcare

This title is part of the Healthcare Administration list.

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Dynamics of Institutional Change: The Hospital in Transition

This thorough and detailed text outlines a model of effective, emergency mental health treatment and services. It aims to prepare mental health professionals at all levels to provide state-of-the-art, community-based, mobile, emergency mental health services and treatment, whether in the street, the patient's home, a temporary shelter, the emergency room, or the clinic. Security, legal, ethical, and administrative issues are also addressed including how to coordinate with and gain the cooperation of various community agencies.

University of South Carolina, Charleston. Presentation of the author's model of a crisis intervention program for the mentally ill. For mental health therapists and crisis management staff. Discusses community based solutions. DNLM: Emergency Services, Psychiatric - organization & administration - United States.

The authors don't miss a thing in their manual on modern-day emergency mental health care. They provide a well-organized, detailed handbook on the "field of emergency psychiatry [which] is truly in its infancy." Subjects range from an overview of the structure of an emergency mental-health program to its treatment of different types of patients, from regular ongoing operations to participating in disaster relief, from administration and staffing to community relations. Zealberg and Santos have medical degrees in psychiatry and have worked in the areas of the private sector, government, and education. Puckett has a degree in Social Work. All three are from the U. S. Southeast.

Emergency psychiatry has become such an important issue for health-care professionals because budget restraints in the field have led to a greater emphasis on "alternatives to costly hospitalization of patients." Yet this growing importance of emergency mental-health care in the general field of medical care has not resulted in related guidance and training in upgrading emergency mental-health facilities, personnel, and operations. This "Comprehensive Emergency Mental Health Care" is a timely, authoritative manual for needed improvements in this area by authors who are leaders in the field.

The title of Part Two, "Nuts and Bolts of Program Operation," conveys the authors' approach throughout the book. In the seven sections of this chapter, considerations about the space and equipment for an effective emergency health-care operation to legal and ethical issues involved in such care are covered. Three of the sections are put in terms of protocols for different aspects of emergency health care. This approach takes into account the professionalism called for in such health care with the importance of awareness of the legal and ethical issues entailed in it. The protocols deal with field work, collaboration with the police, and the organization and interaction of personnel in a mental-health care emergency room.

The treatment of the protocols regarding field work begins with "Goals of a Mobile Visit." Among these are "to assist and respond to the patient's immediate dilemma" and "to provide support and structure in an unstable situation." This is obviously a challenge to emergency mental-health personnel who are probably at first unsure of a patient's particular mental problem and are trying to get control of a rapidly changing, potentially dangerous situation which could bring harm to themselves, the patient, or others. Factors that have to be kept in mind in accomplishing the four primary goals listed are the mission of the mobile crisis program; educational, research, and clinical components of the program; and state government policies and procedures. This work is invaluable in educating and devising training for personnel whose responses require considerations ranging from immediate treatment and gathering information for the emergency-care unit to government regulations and liabilities. The authors go into depth on observing the primary protocols by taking the reader through each of the stages of a typical response. The response is broken down into three main stages--before, during, and after the mobile visit. The "Before" stage involves assessing the crucial question of whether a mobile response is appropriate; and if so, finding out as much as possible about the situation quickly and accurately. The "After" stage includes proper follow-up.

The protocols of the chapter on field work center on meeting the goals of a "mobile visit" beginning with the initial phone contact coming in to the emergency center. Arrival at the scene calling for emergency care, danger signs of a patient requiring care, and awareness of cultural elements are among the topics dealt with keeping in mind the safety of the emergency-care workers and the needs of the patient. In the treatment of this topic, "Tips on Interviewing" are provided. Also noted is the section in another chapter on "The Telephone Encounter." As mentioned at the start, the authors don't miss a thing.

The handbook ends with the chapter "Crash Course in Medical Psychiatry for the Nonphysician." Here the authors introduce readers to the brain and nervous system, the physiological aspect of mental disorders. They also go over in considerable depth for the lay reader the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association used to classify various mental and personality disorders and guide treatment of them. With the important place of drugs these days in treatment of mental troubles, in this last chapter the authors also provide an overview of "psychopharmacological treatment" of them. Although the nonphysician of course cannot administer drugs, this chapter is relevant to emergency mental-health workers for understanding and recognizing the effects--i. e., symptoms--of a patient's taking of or failure to take prescribed medications for a mental condition.

The emergency response is a main focus of the book. But as anyone in health-care knows, such response is the tip of the iceberg. Thus, the subjects include others figuring into this growing area of health care. Different sections apply to workers at different levels and in different operations of an emergency health-care unit besides those connected directly to the response. The straightforward table of contents and headings of sections within the chapters along with the detailed--twelve pages of close-spaced, relatively small type--index enables the varied personnel of a unit to readily find material of interest and relevance to their particular role. Such material could be principles, tasks, and techniques of fundamental and ongoing operations. And the handbook also has use as a quick reference to prepare for any kind of emergency situation that arises. In one Part, the authors outline emergency care for different types of patients; among these adolescents, the homeless, V.I.P. patients, and suicidal or violent individuals. Using the emergency situations arising from devastating hurricanes in South Carolina and Florida in the early 1990s as test cases, the authors relate typically relevant, detailed, and experienced guidance for emergence mental-health responses to natural disasters. This section also has relevance for response to terrorist attacks which could happen in the future.

The authors note that they wrote this book because "much of the literature in emergency psychiatry is dated...and often poorly controlled." "Comprehensive Emergency Mental Health Care" succeeds in making available to emergency health-care professionals an authoritative text and handbook that is up-to-date and usefully organized.

Describes a unique approach to mental health care that brings treatment to the patient in crisis, based on the authors' crisis intervention model pioneered in South Carolina. Outlines mobile emergency mental health services and treatment techniques, and discusses legal, ethical, and security issues. Includes a crash course in medical psychiatry for the nonphysician, reviewing the DSM-IV system and psychopharmacological treatment. For physicians, social workers, nurses, and psychologists, Annotation c. by Book News, Inc., Portland, Or

The complete guide to a revolutionary approach to mental health care - an approach that averts the need for hospitalization by bringing treatment to the patient. Mobile crisis programs are not only the most helpful to patients in crisis, but also the most economically feasible foundation to a successful mental health care system.

"This very readable, practical book presents an excellent outline of emergency behavioral health services. . . .

"The authors are practicing psychiatrists and teachers, and their expertise in both of these areas is evident in their writing. Their level of comfort with this subject and their low-key approach is obvious even in the section titles, such as Nuts and Bolts of Program Operation, and Crash Course in Medical Psychiatry for the Nonphysician. . . .

"Comprehensive Emergency Mental Health Care is written for a multidisciplinary audience, assuming a team approach to treatment. It moves from organizational theory, with attention to fiscal and political realities, to operational detail. Attention is given to the position of emergency and mobile services on the full continuum of mental health care. The emergency treatment team, as the authors envision it and have organized it, moves out of the confines of a particular building or institution, away from the traditional triage service to one that can provide definitive treatment in an impressive, modern-day version of the house call. . . .

"It is into such a high-pressure environment that this book brings order and optimism where there so often can be chaos. Front-line staff need training and support. Administrative organization must be logical and accessible. The services should have a sense of overall mission as well as day-to-day goals to focus the work. Drs. Zealberg and Santos have faces these challenges and given us a guidebook that can be useful to those in training, in practice, and in management."

Joseph J. Zealberg, M.D. received his medical degree from the Medical College of Pennsylvania and his residency training in psychiatry at the University of Virginia. He served in the National Health Service in southwestern Virginia, later becoming Director of the Emergency Psychiatry Service/Mobile Crisis Program in Charleston, South Carolina. He is currently in private practice in South Carolina and is Clinical Professor of Psychiatry at the Medical University of South Carolina.

Alberto B. Santos, M.D., is Professor of Psychiatry and Behavioral Sciences at the Medical University of South Carolina in Charleston. He is co-editor of Innovative Approaches for Difficult to Treat Populations . Dr. Santos has directed the psychiatry residency training program of MUSC since 1982. His educational background includes an undergraduate major in psychology and a master's degree in experimental psychology. He completed medical school and psychiatry residency training at MUSC. He finished his fellowship at the NIMH Psychiatry Education Branch. He is a fellow of the American College of Psychiatrists and the American Psychiatric Association. He has published over one hundred journal articles and three books.

Jackie Puckett is an Assistant Professor of Social Work Limestone College. He finished his B.S.W. at Clinch Valley College of the University of Virginia, M.S.S.W. at the University of Tennessee�and is a Licensed Master Social Worker. His areas of interests lie in program development in the areas of Aging, Mental Health, Emergency Psychiatry and Family Services.