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" Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document "
Nordstrom, Kimberly; Berlin, Jon S.; Nash, Sara Siris; Shah, Sejal B.; Schmelzer, Naomi A.; Worley, Linda L.M.
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AL
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| Record Number
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932772
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| Doc. No
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LA71z0q1n8
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| Language of Document
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English
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| Main Entry
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Nordstrom, Kimberly; Berlin, Jon S.; Nash, Sara Siris; Shah, Sejal B.; Schmelzer, Naomi A.; Worley, Linda L.M.
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| Title & Author
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Boarding of Mentally Ill Patients in Emergency Departments: American Psychiatric Association Resource Document [Article]\ Nordstrom, Kimberly; Berlin, Jon S.; Nash, Sara Siris; Shah, Sejal B.; Schmelzer, Naomi A.; Worley, Linda L.M.
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| Title of Periodical
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Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health
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| Volume/ Issue Number
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20/5
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| Date
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2019
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| Abstract
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The treatment of severe mental illness has undergone a paradigm shift over the last 50 years, away from a primary emphasis on hospital-based care and toward community-based care. Some of the forces driving this deinstitutionalization have been scientific and patient-centered, such as better differentiation between acute and subacute risk, innovations in outpatient and crisis care (assertive community treatment programs, dialectical behavioral therapy, treatment-oriented psychiatric emergency services), gradually improving psychopharmacology, and an increased appreciation of the negative effect of coercive hospitalization, except when risk is very high. On the other hand, some of the forces have been less focused on patient needs: budget-driven cuts in public hospital beds divorced from population-based need; managed care’s profit-driven impact on private psychiatric hospitals and outpatient services; and purported patient-centered approaches promoting non-hospital care that may under-recognize that some extremely ill patients need years of painstaking effort to make a community transition.
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