Adolescents on a general hospital psychiatric unit: problems and remedies

The care and treatment of adolescents on an adult acute psychiatric unit in a general hospital can pose serious problems for unit staff. Adolescents with behavior or character problems who prove violent or manipulative can disrupt treatment of both the adolescent and adult patients on the unit. Yet the demand for immediate treatment for many adolescents and the accessibility of general hospital psychiatric units often mean that adolescents may placed there inappropriately. This paper describes how an adult acute unit in a general hospital solved the problems caused by acting-out, manipulative adolescents on the unit. A committee found problems in inappropriate admissions, unworkable treatment plans, management of acting-out behaviors, case disposition, and staff attitudes. Remedies came in the form of more specific admission and discharge guidelines, strict enforcement of those guidelines, staff discussion of treatment plans, an inservice education program, and improved liaison with community facilities for adolescents.