fluffydice...
I was able to locate a case study on the Psychiatric Services
website, which is an Online Journal of the American Psychiatric
Association, in an article titled 'The Young Adult Chronic Patient:
Overview of a Population', by Bert Pepper, M.D., Michael C. Kirshner,
Ph.D. and Hilary Ryglewicz, A.C.S.W. The case study contained within
the article follows a patient for 12 years, from his voluntary
involvement with an outpatient clinic of the Rockland County
Community Mental Health Center in Pomona, New York, at the age of 18,
to his involuntary hospitalization in the same facility shortly after
his 30th birthday.
Having spent 20 years working in the field of mental health in
states across the country, I can tell you that the patient's
story is not unusual.
I should also clarify: Your question focuses on a patient
who is admitted to a psychiatric hospital, and the outcome
of the hospitalization, as though the process might be
similar to (but longer than) a stay in a medical hospital
which then results in some resolution of the illness.
In fact, this was historically the approach in dealing with
mental illness, but, after many decades, it finally became
clear to mental health professionals that there was no
'cure' for mental illness, and keeping patients hospitalized
as long as they had symptoms usually meant *forever*, which
was not practical for the system or the patient, since those
who remained hospitalized for as long as 20-40 years lost the
ability to function outside the hospital.
This resulted in the revolution which emptied the hospitals
en masse and began the focus on outpatient treatment centers
(sadly, this exodus occurred before there was an adequate
network of such centers in place).
So, for at least 3 decades, there has been an increasing
tendency to minimize the length of hospital stays. This
is even more the case now that public mental health systems
are becoming increasingly involved with managed care.
As a result, actual hospitalization is essentially limited
to involuntary admissions where the patient is assessed as
a potential danger to self or others - suicidal or homicidal.
The case study presented in the article is fairly typical
of current treatment, in that it is largely outpatient and
voluntary, so the patient has the right to refuse treatment,
miss appointments, quit his meds, and take street drugs,
all while living with his family. Occasionally, the patient's
ability to function will become so impaired that neighbors
will call the police and they will then be admitted to a
hospital or clinic on an involuntarily basis. However, as
soon as they are relatively stable on medications, and
demonstrate the ability to attend to ADLs (activities of
daily living), they are likely to be discharged as soon as
possible, especially in a managed care system.
This treatment dilemma, and others, are discussed at length
in the article which surrounds the case study of 'Mr. J'.
To read the case study, scroll down, about halfway, to where
it says "A Case Study", but I believe you'll find the entire
article to be relevant to your question:
http://psychservices.psychiatryonline.org/cgi/content/full/51/8/989
Since there are numerous terms that are specific to the
field of mental health, I would be more than happy to
clarify any questions that arise from reading the article.
Please do not rate this answer until you are satisfied that
the answer cannot be improved upon by means of a dialog
established through the "Request for Clarification" process.
sublime1-ga
Searches done, via Google:
"case study" "mental patient" hospital
://www.google.com/search?q=%22case+study%22+%22mental+patient%22+hospital |
