general practice of psychiatric institution (1)

PSYCHIATRIC INSTITUTION 1

General Practice of Psychiatric Institution

Abstract

This research is based on general practice in the psychiatric institutions. It involves a

qualitative research method that that uses three peer-reviewed journal article containing

information about the scope of psychiatry, emerging issues in accommodating patients and

highlight on medication of mental illness. Mental illness is a prevalent disease in the United

States and receives a lot of attention. Psychiatric institution that involves in the treatment

includes hospitals, schools, community-based care centers and juvenile facilities. Findings of

the study indicate that mental illness is on the rise. The federal government should streamline

policy issues and increase the budgetary allocation towards psychiatric institution.

Contentious issues regarding on the assessment and qualification of mentally ill to seek

medication should be addressed.

Key Words: Mental disorders, Psychiatric institution, deinstitutionalization, Hospitals,

Community-based Care.


Introduction

Psychiatric problems are prevalent in United States and internationally. Multiple

researches indicate that one out of four people in the United States suffer from one or more

mental disorders. A study by National Comorbidity Survey Replication (NCS-R) conducted

between 2004 and 2009 indicated that 22.8% of the population suffer from a diagnosable

psychiatric disorder every year (American Psychiatric Association, 2013). Studies also

indicate that the four leading psychiatric disorder include, depression, schizophrenia, bipolar

and anxiety. Out of the mentally ill people, many suffer from multiple disorders.

Studies indicate that about 20% of youths between the ages of 13 to 18 suffer from

severe psychiatric disorders. Below the age of 8, fewer people suffer from mental disorders,

with studies indicating a drop to only 13% of the total population in a given year (American

Psychiatric Association, 2013). Depression is among the leading psychiatric disorders in

America. About 6.7% of the adult population (18.7 million people as per 2004 census),

indicate severe signs of depression (American Psychiatric Association, 2013). Anxiety

disorder is the worst psychiatric problem affecting the adult population with statistics

indicating that anxiety affects 18.4% of adult population (In Shally-Jensen, 2013). Anxiety

disorder ranges from panic disorder, obsessive-compulsive disorders, posttraumatic stress

disorder, and phobias. Schizophrenia and bipolar are among the common mental diseases

demand high attention in the psychiatric institutions. Studies indicate that the federal

government increases its budgetary allocation every years to cater for the increasing cost of

medicine to schizophrenia and bipolar. Statistics indicate that about 1.1% of the adult

population suffers from schizophrenia, and 6.7% suffer from bipolar (American Psychiatric

Association, 2013).

Studies also indicate a high correlation of psychiatric disorders with substance abuse.

In fact, many medical practitioners attribute many cases of mental disorders to substance


abuse. Studies indicate that 32% of people who use substance abuse show signs of mental

disorders (American Psychiatric Association, 2013). Figures also relate mental health

problems with increased social problems. Approximately 46% of the homeless people in

America suffer from severe mental problems. Studies indicate that the rate of mental

problems is relatively higher with people with history of state prisons or local jail (American

Psychiatric Association, 2013). Figures indicate that 23% of people with history of prison

indicate serious symptoms of mental disorder. Study indicate that mental disorder is prevalent

in juvenile justice system with statistic indicating that at least 70% of the juvenile suffer from

one of the mental disorders (American Psychiatric Association, 2013).

Women are the most affected by mental disorders with statistics indicating that the

rate is nearly twice of that of men. Nearly twice (12%) of women are affected with serious

depressive disorders as compared to men (6.6%) (American Psychiatric Association, 2013).

The estimates translate to approximately, 12.4 million women and 6.4 million men. Studies

indicate that treatment of mental disorders focus more on adult population above the age of

25 years (three times higher) as compared to children below the age of 15 years (In Shally-

Jensen, 2013).

Individuals with severe mental disorders face increased danger of developing chronic

disorders. Medical records in America indicate that people with mental disorders 25 years

earlier than other people do. School records indicate that the high rate of dropouts is directly

proportional to mental disorders in learning institutions. Suicide is among the highest cost of

death in the United States (more than homicide), and third leading cause of death to adults

between ages 14 and 24 years (American Psychiatric Association, 2013). Studies indicate that

more than 90% of people who commit suicide suffer from one or more mental disorder.

Pundits argue that the rate of mental disorders is overrated and do not represent the

true reflection of American people (American Nurses Association, 2006). I concur with the


argument of some critics that the high figures indicating mental disorders are an attempt of

multinational medicine companies to mint millions of dollars from sale of drugs to cure these

diseases. Many psychologists argue that anxiety is common phenomena to human being and

should not be misconstrued as a mental disease. In fact, some psychologists argue that

medication offered to cure anxiety only escalate the problem instead of curing. However,

severe cases of mental disorders such as schizophrenia, bipolar and post-traumatic stress

disorder require medication. The current figures indicate that 22% of the American

population suffers from mental disorders (American Psychiatric Association, 2013). It is

important to conduct more research from the current studies to find the exact figures of

mental disorders cases that should seek services of psychiatric institutions. The current

number of psychiatric institutions cannot accommodate the high numbers of psychiatric

problems. The research will focus on general practice of psychiatric institutions in an attempt

to examine the services offered and the mental conditions that require psychiatric services.

History Institutions and treatment

Mental disorders and setting aside specialized wards to treat the diseases dates back to

eighteen-century in the United States (American Nurses Association, 2006). Private and

public hospital recognized the important need to cure and treat mental disorders patients with

the same agency as people suffering from other chronic diseases. Most mentally sick people

before the eighteenth century dependent on family members for cure and care, because there

was little medical knowledge and focus to mental disorders. Many regarded mental disorders

as strange thoughts and behavior. However, people with severe symptoms of mental disorder

could not cohabit effectively with the rest members of the society.

Phycologists develop theories in attempt to explain the strange behaviors. In early 19 th

century psychologist, Sigmund Feud came to America from Europe to give lectures of

depression disorders. He gave lectures about curing “hysterical” physical symptoms in Clark


University in 1909 and opened up debates on treatment of mental disorders. Sigmund

suffered severe depression in his life and at one time, he recommended cocaine as cure for

depression before doctors discovered that it had severe medical implications. Sigmund was

among the first psychoanalysts to postulate that overall wellbeing included stable mental

conditions to all patients. Hospital began considering mental disorders as serious diseases

and by late eighteenth century, many private and public hospital wing set aside specialized

ward to cater for mental problems. However, many hospitals depended on donations from

wealthy individual and well wishes to cater for psychiatric problems (American Nurses

Association, 2006).

The 19th century ushered in new European ways of treating mental disorders regarded

as “moral treatment”. The treatment based on the idea that people who showed signs of

mental disorders the patients needed kind treatment and care as some parts of their minds

remained rational. Moral treatment to people suffering from psychiatric problems was the

first step to recovery. The moral treatment repudiated the societal harsh treatment and

isolation and called for specialized treatment in hospitals. Mental hospitals provided a quiet,

peaceful setting for recreation and gave mental patients privileges that offered in hospitals.

Quacker community in Philadelphia was among the first hospitals to establish the moral

treatment duped as “Friends Asylum”. Other private and public hospital followed and

established secluded hospitals to deal with cases of mental disorders. McLean Hospital was

built in Boston in 1811, followed by Bloomingdale in Mornigside and New York Hospital

soon followed.

Initially, the cost of treating mental disorder was very high and only specialized to

private patient that could afford the cost. Dorothea Dix (a schoolteacher) became a prominent

voice in advocating for plight of the mentally ill, especially the poor in all states. By 1870s,


her voice was heard, and at least one psychiatric institution was built in each state. It became

the responsibility of the state to fund the psychiatric institution in every state.

By the onset of the 19th century, many institutions that offered psychiatric treatment

were under siege. Many state suffered economic restraint considering the high rise of patients

who sought psychiatric services. The number of patients rose exponentially and surpassed the

states’ economic capability and willingness to handles the increased cases of mental

disorders. Therapeutic role also played a role in the siege. Some patient preferred to seek

services of therapists instead of visiting psychiatric institutions.

By 1950, medical services had improved significantly in the United States and

sounded the death knell for the moral treatment. A new system of treatment was established

that involved nursing homes and medicine treatment (Chlorpromazine) of psychiatric

problems. A new system of mental care introduced in late 1950s focused on treating and

returning the mental disorder patients to their families and communities.

Today, the treatment of psychiatric patients has revolutionized. Only a bunch of

historic hospitals still exists. The psychiatric care and medication is delivered through a

rigorous web of services that include, short-term and general-hospital-based care units, crisis

services, outpatients services (on twenty-four-hour basis), psychopharmacological and

psychotherapeutic treatments (Kemp, 2007).

Modernity in Psychiatric Institution and Treatment

Modernity in the field of psychiatry encompasses societal structure, which includes

both nonmaterial and material culture. Culture is ever evolving so do the treatment and focus

of psychiatry. Modernity in the treatment of the mentally ill has shifted focus on the

technological advancement, changes in the belief system, morals, behavior, and individual

health.


Psychotherapy and psychiatric treatment has taken the center stage in the general

treatment and well-being in the modern healthcare systems. Mental treatment is treated on an

inpatient and outpatient modalities depending on the severity of the situation and specific

aspect of impairment. The current focus on treatment of mental illness takes into account

both the prevention and treatment interventions. The number of people requiring treatment of

mental illness is increasing in concurrent rate with the increase in population. Although the

government have continuously increased the budget allocation set aside for treatment and

accommodating the mentally ill who are homeless, many more remain under severe

conditions (Bender, Pande, & Ludwig, 2008).

The modern practice of psychiatry puts mental treatment in three categories that

include mental illness, learning disabilities, and personality disorder. The treatment of

psychiatric problem have evolved to become more biological and integrated in the modern

day medicine field and less conceptually isolated. Not all mental disorders require medical

intervention in psychiatric institutions, some problems such as personality disorders are

primary handled by therapists. The scope of study of mental problems has also expanded

drastically to include neuroscience, psychology, medicine, biology, biochemistry, and

pharmacology. The approach in treatment of the mental illness has shifted, conversely, and

uses biomedical diagnostic criteria in assessing the symptoms and treatment. Despite the

evolution and shift in assessment of mental illness, the methods have not reconciled

sufficiently in all psychiatry fields to settle the contradictions of psychopathology. Some

treatment differs, with some psychoanalysts advocating for therapeutic intervention, while

psychiatrists calling for use biological intervention (commonly medicine).

Methodology Used in the Study

The research used qualitative methods. Four peer-reviewed journals in the field of

psychiatry were selected. The inclusion criteria focused on keywords: psychiatry and mental


disorders and treatment, current issues in psychiatry. Only journal that contained psychiatric

information, history, records, and current trends in the field of psychiatry were considered in

the literature review from 1960 to 2014. Three journals containing information regarding the

history of the psychiatry in the United States were chosen based on the credibility from the

source. The credibility of the three articles used dependent on source, mainly medical

journals, information, strictly regarding United States cases of mental disorder and period

(1960 -2014). The journals includes ““Psychiatric-Mental Health Nursing: Scope and

Standards of Practice” Published in Draft Revision 2006,” “America’s Failing Mental Health

System: Families Struggle to Find Quality Care” (2008),” and “Psychiatric Mental Health Nursing

Scope” Published in Draft Revision 2006.” During the search, I found three other article which have

insightful information regarding my topic, but I failed to use them become the scope of research was

outside the United States.

Literature Review

The first article I used in the research was, “Psychiatric-Mental Health Nursing:

Scope and Standards of Practice” Published in Draft Revision 2006. The article was relevant to

my studies because it focused on the scope of mental health. The abstract of the article

emphasized on the need for the public to use psychiatric hospitals freely and as prescribed by

the physicians. The second article was a journal article by Maia Szalavitz, “America’s Failing

Mental Health System: Families Struggle to Find Quality Care”. The article was relevant to my

research as it highlighted the current trends and challenges facing psychiatric institutions and treating

of mental patients in general in the United States. The last article I used in the research was “A

Literature Review: Psychiatric Boarding” by David Bender, Nalini Pande, and Michael Ludwig. I

choose the article because the abstract highlighted that it was an official report to the U.S

Department of Health and Human Services. I presided to use the since it was directly relevant to my


research in determining the extent of services offered in psychiatric institution and their relevance

including boarding and Existence.

The first article I used in this research is, “A Literature Review: Psychiatric Boarding” by

David Bender, Nalini Pande, and Michael Ludwig. The introduction part contains information about

the boarding facilities. It highlights the success and the challenges of the boarding offered to

mentally ill patients. The number of beds to accommodate the severe psychiatric patients has

increased over the years. Boarding facilities improves the quality of services and offer an opportunity

for doctors to monitor patients over 24 hours. Boarding inpatients consumes many resources and

prolongs the time taken to offer services of treatment. A 2008 report indicated that boarding facilities

strictly accommodated severe patients ranked in emergency department category. Since 2007, there

has been a higher increase of patient requiring boarding facilities although the number of the

available opportunities does not match the requirements. The number of patients requiring medical

facilities has increased from a record of 90.3 million to 119.2 million from 1990- 2009. Because of

the sharp increase in the mentally ill patient, a new system of using community mental health

services has emerged.

The article used statistics from state psychiatric hospitals to conduct the research. The article

focused on qualitative analysis on the pattern in the boarding facilities, service offering and the

current problems and trends experienced in boarding the mentally ill patients.

Capacity Issues

Increase in the number of mentally ill patients has led to rise in the placing of psychiatric

patients on inpatient, outpatient, and community-based treatment facilities. The deinstitutionalization

of the medical patient has seen the number of inpatients in hospitals reduce from around 400,000 in

1970 to approximately 50,000 in 2006 (Bender, Pande, & Ludwig, 2008). The shortage in bed in

hospitals to accommodate the mentally ill is a common problem in all states according to a recent

research conducted by ACEP in 2009. Apart from acute shortage of bedding facilities, the


psychiatric treatment has also suffered from lack of coordination and lack of resources to treat the

outpatient patients. Studies indicate that over the past decade there has been a rise in the number of

patients requiring emergency treatment. The rise has been considered as a lapse in offering effective

services to the outpatients mentally ill. The community-based approaches to cater for the mentally ill

have experienced a large success but cannot accommodate the surging number of the mentally ill

(Szalavitz, 2012).

There is an increase in children patient, according to documented cases in Yale-New Haven

Children’s Hospital. Statistics across many states indicate that number of children suffering from

mental illness is increasing sharply. During 2008 studies in Massachusetts indicated that children

spent at least 20 811 days in psychiatric wards (Bender, Pande, & Ludwig, 2008). The research also

indicated that about 23% of mentally ill patients in community-based care system suffered from

acute shortage of resources. Rural community-based care system were the worst affected by the

shortage of resources forcing many patients to transfer to psychiatric hospitals outside the

community. Records from Maine Rural Health Research indicate that about 43% of mentally ill

cases were transferred to local mental health providers. The record is consistent with figures from

other state, which indicate that the level of resources is not matching the number of cases.

Lack of funding is a major issue facing psychiatric institutions. A research by AMA in 2008

noted that the major problems experienced especially in the community-based centers is a result of

failure to direct more funds in these institution. Deinstitutionalization of more funds has continually

been appropriated to hospitals and less allocated to community-based institutions that deals with

psychiatric problems (Bender, Pande, & Ludwig, 2008).

Unnecessary Inpatients Admission

Mentally ill patients are affected by several factors that include legal and liability issues;

legal issues has been cited as the highest contributor to increased rate of admission of many patients

to boarding facilities. The decision to admit a patient who is suffering from mentally ill condition is


always a complicated situation. It presents the physicians with a dilemma with to put the patient of

boarding facility or use outpatient services (Szalavitz, 2012). Sometimes family members, relatives

and members of the community push through legal system for the mentally ill to be accommodated

in boarding facilities. The consideration of liabilities put clinicians under increased pressure to

accommodate the mentally ill patients. Clinicians might be prosecuted if the mentally ill commits

suicide under their treatment.

Contradictions among Psychiatric institutions and medication Process

The second article used in the study was, “America’s Failing Mental Health System:

Families Struggle to Find Quality Care” (2008). It contained information on some of the pertinent

issues that are crippling effective services in the state managed psychiatric institution. The article

revealed that there is little coordination of care and medical services among hospitals and agencies.

Among the psychiatric institution that focuses with the treatment and care of the mentally ill include

hospitals, education institutions, disability, child welfare and law enforcement. All the psychiatric

institution must work in harmony to ensure that all the needs of the mentally ill issues are articulated.

For example, a physician may recommend the child to residential treatment while a therapist might

recommend the same situation of a child to a juvenile justice system. The lack of coordination

contradicts family member on the best system to adopt when planning to put their mentally ill

children in the best correction facilities.

The contradiction of role has forced the Congress to cut the budget spending on the money

used to cater for the mentally ill by 10% until the problems are solved. Reducing the budgetary

allocation affect all institution associated with offering psychiatric help and derail services. An

estimated 1,300 severe ill patients risk losing medical services if the problems hampering the

psychiatric institutions are not ratified imminently. An addition of about 320,000 patients will risk

losing early intervention.


Depending on the diagnostic procedure used, the mentally ill patients might enroll for

medicine treatment or non-drug therapy. Non-drug therapies face pressing problems because, unlike

medications, there is no agency that establishes and regulates standards of safety and efficacy.

Evaluating of success treatment in non-drug treatment also depends on the individual therapist

assessment. A study by Individual with Disabilities Education Act (IDEA) 2004 showed that some

patients pull out of the therapeutic intervention because of the high cost associated with treatment

and the little progress achieved from the process. There is a surging increase in drug treatment.

Patient even with the list indication of disorders such as anxiety are constantly using drugs to avert

the situation. There is a debate among psychologist and pharmacologists whether to include anxiety

as a disease. The psychologist view anxiety as a normal condition to human that does not require

external invention with drugs, but at times physicians prescribes medicine as a treatment to anxie.

Scope and definition of mentally ill

The third article used is, “Psychiatric Mental Health Nursing Scope” Published in Draft

Revision 2006, show the journey through which the psychiatric institution has transcended through

history. It traces the modern treatment of mental problems in the 19th century and defines the realm

and parameters used to define a mentally ill person in the United States.

The definition and the scope of mental illness were revised in 1999 to address policy issues

in the United States. Mental disorders have shifted from traditional focus and taken a more inclusive

dimension. Current medical practitioners recommend that mental disorders are real health

conditions.

Psychiatric problems cause a great impact on economic and social realms. Mental

disorders force the government to establish psychiatric institutions in the United States in

every state as key government priorities. Statistics indicate that they are at least 13

psychiatric institutions in every county. Serious psychiatric disorder constitutes about $190.2

billion as lost earning every year. The government spent approximately $112 billion in


treating and catering for patients with serious mental disorders. Most of the severe mental

disorders patients are homeless and require housing in the psychiatric institutions.

Schizophrenia, bipolar and depression are the leading cause of hospitalization. Independent

research, differ with records in psychiatric institution indicating that the rate of psychiatric

problems is higher than what is recorded in the medical institutions. Independent researches

indicate that about 34% of the American population suffers from one of the psychiatric

problem. Many victims of psychiatric problems prefer taking medication from chemists. A

study conducted by psychiatric Joelem (2008) indicated that many people who showed signs

of mental disorders avoid visiting psychiatric institutions for fear of stigmatization by friends,

relatives, and community members. Other members do not visit therapists or medical

institutions because of the cost associated with treatment of the mental illness.

Findings

Mental illness is a prevalent disease in the United States. Findings indicate that about 23% of

the population suffers from one or more forms of mental illness. Treatment of the disease started

back in the 18th century but have revolutionized over the years. There are many psychiatric

institutions that focus on mental illness, among the agencies include schools, community-based care

institution, juvenile, hospitals and law enforcement agencies. The federal government in conjunction

with states has constantly put measures to address the increasing number of psychiatric problems. In

1960, the government opted for the deinstitutionalization as a system. The system focused on

reducing the number of the mentally ill in hospitals and instead sending them to community-based

institution to receive care. Mental illness patients use either drug treatment or therapeutic treatment.

The treatment and early intervention method play an important role in containing the mental

condition and prevent it from developing to chronic.


Despite the success, there are major issues regarding psychiatric institution and treatment in

the United States. Although deinstitutionalization has reduced the number of patient’s hospitals, it

has led to an increase in the number of community-based boarding. Study indicates that there is a

high rise of mental illness cases. The high rise has crippled the capacity of many states to handle the

disabled. The budget allocation towards treatment and intervention of mental patients is not enough

to offer effective services. The research also finds out that not all the admitted patients in hospitals

genuinely require treatment. Sometimes succumbs to admit patients out of few of prosecution, in

case of legal actions. Furthermore, findings indicate gaps in coordination of the psychiatric

institutions and affect general offering of services.

Discussion

According with the findings, although there is high success in psychiatric institution and

treatment, there are various issues that need imminent intervention. Policy area has failed to address

the gap in various agencies that offered services to mentally ill. Considering the high rate of mental

illness cases, the policy issues should monitor and regulate activities of all agencies. Early

intervention should be given the same weight as treatment as a primal focus to reduce the surging

rises of mental cases.

Findings reveal that many patients admitted do not necessary require services and, in fact,

slow the service delivery. Clear procedure and a basic criterion of assessing patients who need

boarding facilities should be established in every state (Kemp, 2007). The current finding show

worrying indications. Although there has been a great revolution since the start of treating mental

illness, there is no clear definition or diagnostic procedure that guides patients who should be put

under medication.

Conclusion

Mental disorders are among the most common and disastrous diseases affecting the

American population. Hospital and community-based institution help in intervening and treatment of


the mental illness. The numbers of mental illness cases have risen exponentially and current

indication point that the trend will continue. Since the inception of the treatment back in 18th century,

intervention and treatment has undergone a revolution. Early methods focused on hospitalizing

mental illness patients and using medical asylum as a form of treatment. The current psychiatry

system involves the use of drugs, and therapeutic intervention to both inpatient and outpatient to treat

the disease.

Although there have been major success in intervention and treatment of mental illness in

the United States, several issues has derailed institutions concerned with the treatment. Since

deinstitutionalization of the mental patients to community-based care to reduce congestion in

hospitals, there has been frictions in several agencies concerned with mentally ill patients.

Psychiatric institution lacks enough funds to accommodate all patients and offer effective services.

The level of coordination among the agencies thwart efficient offering of services. There is a

division among the doctors and therapists on weathers all cases of mental disorder need drug-

medication. More research needs to be done to ascertain the specific category of condition that

warrants medicinal treatment and accommodation in the psychiatric institutions.


References

American Nurses Association. (2006). Psychiatric-Mental Health Nursing: Scope and

Standards of Practice.

American Psychiatric Association. (2008). Diagnostic and statistical manual, mental

disorders.

Bender, D., Pande, N., & Ludwig, M. (2008). A Literature Review: Psychiatric

Boarding.The Lewin Group. Retrieved from

http://aspe.hhs.gov/daltcp/reports/2008/PsyBdLR.pdf

In Shally-Jensen, M. (2013). Mental health care issues in America: An encyclopedia. Santa

Barbara, CA: ABC-CLIO.

Kemp, D. R. (2007). Mental health in America: A reference handbook. Santa Barbara, CA:

ABC-CLIO.


Szalavitz, M. (2012). America’s Failing Mental Health System: Families Struggle to Find

Quality Care. TIME.com. Retrieved from

http://healthland.time.com/2012/12/20/americas-failing-mental-health-system-

families-struggle-to-find-quality-care/