The impact of patients with chronic character pathology on a hospital inpatient unit

Inpatient psychiatric facilities are admitting an increasing number of young patients with chronic character pathology. Hospitals must explore the impact these patients have on the treatment facility and the risks inherent in their treatment, including the possibility of decreased milieu specificity, increased staff regression, and loss of cost-effectiveness. These risks are system responses that go beyond individual staff countertransferences. Possible remedies include refined indications for inpatient psychiatric treatment, tailoring of milieu functions to fit individual patient needs, explicit accountability of administrative and supervisory structures, and involvement of families in the formation of the initial treatment alliance.