Hospital based psychiatry departments tend to address a variety of problems in several fields. First, the department is usually divided into different units depending on the severity of the condition that is presented by the patient. Inpatient units usually serve patients whose conditions are more severe. Such patients are usually those who present a potential danger to themselves and/or others. If a new patient is screened and hospital staff members find that the patient has either suicidal or homicidal tendencies that he/she is likely to act on, the patient will be admitted to an inpatient unit. In this unit, the patient can be kept safe while he/she is being treated. Patients who become very disorganized and are unable to function by themselves will often be referred to an inpatient unit. Similarly if a patient needs to be detoxified from drugs and the process requires considerable medical supervision, the patient will be admitted to an inpatient substance abuse unit. In this unit, the patient can be closely monitored, physically and medically. The less severe conditions which require less medical supervision are referred to outpatient clinics, where the patient comes to the hospital for specific appointments to address the specific problem which he/she presented during the intake process.
Non drug-related outpatient clinics, which are based in hospitals, usually serve patients who present with symptoms associated with depression, anxiety and psychosis. Such patients usually present with problems at work, in their relationship with loved ones and with overall coping ability. Many of these patients had very difficult childhoods with issues of deprivation and abuse.
If these patients are manageable with medication and psychotherapy, treatment will continue on an outpatient basis. If, however, a regression occurs and the patient no longer can be treated on an outpatient basis, he or she will be referred to an inpatient unit.
Children with psychiatric problems are also served in the outpatient clinic. Individual, group and family treatment is available.
Some outpatient psychiatry services also have special treatment units which address the needs of AIDS patients who also have mental health issues.
Partial Hospitalization Program
There is a level of care which is in between inpatient and outpatient clinic care. This is partial hospitalization, where the patient comes for the day and then goes home after a day of treatment. This kind of treatment is designed for individuals who have severe problems but who are not dangerous to themselves or others.
Intensive Psychiatric Rehabilitation Treatment (IPRT)
This is a five-day-a-week program where patients return home every day.
This unit provides support to patients who need help with re-entering life. Such help can focus, for example, on skills that are required to find a new job. Patients are primarily given educational training.
Inpatient Substance Abuse Treatment Programs
Inpatient substance abuse treatment programs are divided into short-term detoxification units, and those of longer duration called rehabilitation units or, in short, rehab. In the short-term units, the patient spends a few days to help him/her stop abusing illicit drugs. In the rehabilitation unit, the patient spends about a month. In both the detox and rehab programs, a considerable amount of individual and group treatments are used. Patients are also given educational seminars about drug abuse, and, if appropriate, given medication to help them with the detoxification process.
Outpatient Drug Treatment Services
Chemically Dependent Outpatient Services (CDOS)
This program is designed to help chemically dependent individuals who require a minimally restrictive environment. The program accepts patients who have only minor psychiatric problems. Patients come five days a week. The program is usually completed within nine months to a year.
Mentally Ill Chemically Addicted (MICA)
This program is designed for patients who are diagnosed with having drug problems and mental health issues. Patients come to the program every day and go home in the afternoon. The goal is to relieve the patients of drug addiction and help them become psychologically stable. Patients complete the program in approximately one year.
Methadone Maintenance Treatment Program (MMTP)
This is a program designed for patients who have been addicted to heroin or other opiate- type drugs. The program involves the dispensing of methadone at different dosages to patients. Patients come to the clinic between two and six days a week depending on how cooperative they are. The more cooperative they are, the less they need to come to the clinic and the more they are trusted to take the medication independently. Patients stay on this program for as long as necessary.
Psychiatric Emergency Room.
Some hospitals have an emergency room which is specific to patients with mental health problems in addition to the regular emergency room. Such an emergency room is equipped with staff who are highly trained to deal with psychiatric emergencies and to refer patients to appropriate follow-up care.
Mobile Crisis Team
This is a small, mobile unit which makes visits to the residences of patients who either cannot or do not want to come to the hospital. Clinical interventions are made right at the residence of the patient. A psychiatrist, psychologist and social worker make up the team. The team also makes follow-up appointments for the patient at various clinics.
The Process of Psychotherapy
As part of the treatment process, patients come to individual as well as group psychotherapy. In psychotherapy they are encouraged to talk about everything: about the past, the present and the future; about the stress they had to endure at various times during their lives; about difficult and abusive relationships; about what they think got them ill and what they believe will get them better; about what their aspirations are for themselves, their spouses and children.
The talking helps them hear their own thoughts and helps them think of their lives in a different way. New connections are made between causes and effects. A new understanding develops, and with it, a chance to chart a new course in life that could lead to more happiness and less frustration.
The therapeutic relationship that develops in the treatment with the therapist and the other group members helps the patients develop new approaches to those around them. Such relationships serve to improve the patients’ ability to relate to those they encounter in everyday life. This can lead to less stress and alleviation of symptoms that the patients came to the hospital for.
In addition to the above techniques, staff members may use behavior modification, relaxation techniques and cognitive-behavioral therapy, among others, to help patients overcome their difficulties.
In summary, psychological and psychiatric treatment in a hospital setting provides individuals with a wide range of treatments and a wide variety of treating staff.
The success of the treatment depends, for the most part, on the dedication of the staff and the cooperation of the patient.
Dr. Gideon Freudenthal is a Psychologist at Interfaith Medical Center. He is also in private practice in Manhattan and Brooklyn, NY