A paradigm for treatment of inpatient psychiatric disorders: from asylum to intensive care

No articles, chapters, or texts have been published in the last 5 years that detail a workable model of inpatient psychiatric treatment based on current, drastically changed realities.

We reviewed controlled studies on inpatient psychiatric care and pooled our clinical experience from two academic inpatient units and a Veterans Affairs inpatient unit.

Major changes in systems of care, the population now being hospitalized, the emphasis on practicing evidence-based medicine, and decreased funding of inpatient psychiatric units have necessitated changes in the traditional paradigm of inpatient treatment. We describe the functions that an inpatient unit performs best and detail 1) objectives of treatment with an emphasis on the "focal problem", and 2) the specific treatment interventions, treatment team members, and outpatient links necessary to maximize post-hospital outcome for patient and family.

Given current realities, the treatment paradigm that we recommend has evolved from an asylum-like long-stay model to one that is more like a medical-surgical intensive care unit with an emphasis on rapid diagnosis, psychopharmacological intervention, and laying the groundwork for effective outpatient management. In consequence, the expected clinical outcomes from an episode of inpatient psychiatric treatment are quite different from those of the recent past.