Communicating Psychiatry in a General Hospital November 15, 2019

Managing a psychiatric inpatient unit in a general hospital has unique challenges. Among them is communicating effectively with the rest of the hospital.

Here are four things to get across for a better connection with the rest of the hospital:

  1. Psychiatric disorders are medical disorders that can be treated

Mental health disorders are medical disorders; as the American Psychiatric Associate states “Mental illness is nothing to be ashamed of. It is a medical problem, just like heart disease or diabetes.” Addiction is also a medical disorder. The American Society of Addiction Medicine defines it as follows:

“Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.”

2. But unlike most patients with non-psychiatric disorders, patients with a mental health or addiction disease:

  • May want to hurt themselves or hurt someone else due to severe depression or psychosis
  • Can rarely be diagnosed with a laboratory test
  • Don’t always want to be admitted or accept treatment and may be admitted against their will (they are not cognitive of their illness’s current severity)
  • Often have co-occurring and complex chronic medical diseases

3. Psychiatric services are not going to look or function like other medical services. CMS regulations governing psychiatric services are extensive, different, and in addition those for medical services. Since 2017 this is especially true for inpatient psychiatric units which must meet specific ligature risk requirements in the physical environments of care, as well as furnishings, fixtures and equipment. Even with these safety features in place, procedural mitigations to reduce risk often require 1:1 “arm’s length” close observation.

4. Nursing staff working on a psychiatric unit must have mental health / substance abuse treatment specific training in addition to their medical knowledge. They must also have the sensitivity, practice, support and clarity to handle patients’ frequent outbursts, agitation, and panic behaviors.

Here are some ways psychiatric units can keep the rest of the hospital up to speed with Psychiatry – opportunities for education:

  • Regular psychiatry news/updates section in the hospital newsletter
  • Participation by psychiatric unit leadership in hospital committees (especially quality, safety, electronic medical record)
  • Presentations regarding the volume of primary and secondary psychiatric diagnoses in the hospital or across the hospital system
  • Joint medical-psychiatric nursing presentations – e.g. announcing a new program like tele psychiatric consults in the Emergency Department, quality or safety initiatives
  • Creation and participation in a hospital wide Critical Incident Stress Management team – for more information check out the International Critical Incident Stress Foundation

Schafer Consulting