Phases of Hospitalization
Treatment in a hospital should progress in certain, orderly stages. From the moment a person enters the hospital, the staff should be formulating a treatment plan, with a focus on the ultimate goal of discharge. Patients and family members can be of great assistance in planning effective treatment and in working toward a smooth transition to community living.
The patient’s history is reviewed and immediate needs are assessed (e g. need for suicide precautions). A physician should conduct a physical examination. An interim treatment plan should be developed. Patients who are able, and family members, can assist staff by providing information about recent behavior, hospitalization and medication history, recent outpatient care, and insurance coverage.
After admission, the treatment planning team assesses the patient and writes a comprehensive treatment plan. Treatment plans are a way to stabilize the patient for discharge. Family members and well-functioning patients can offer suggestions about programs; ask for frequent reviews of treatment and, possibly, revisions.
Assessment of Plan
Periodically, the treatment team will review the plan to identify the patient’s strengths and weaknesses, and alter the plan accordingly to best meet the patients’ needs. Family members and patients should report the effects (and side effects) of medication, and how treatment is generally progressing.
Prior to discharge, the staff should hold a discharge-planning meeting. Patients may be included in this meeting, and also family members (unless the patient objects). The written discharge plan should address the patient’s current needs and goals, specify the services to be provided and by whom. Among the areas that should be addressed in the discharge plan are: mental health services, case management, living arrangements, economic assistance, vocational training, transportation and medication.
Whether or not a patient is actually linked to community services depends upon a number of factors. These include whether or not a case manager is assigned, the patient’s status upon admission (voluntary or involuntary status), the severity of the patient’s problems, use of the public mental health system in the past, the family’s involvement in developing the discharge plan, and the patient’s motivation. In theory, patients leaving the hospital should have an appointment at a community mental health service within one week of their discharge.
Outpatient services can be accessed without a prior hospitalization, simply by calling the agency for an appointment. An Intake Secretary will ask for information, including the nature of the problem, name of the potential client, involvement of family members, type of service requested, and financial arrangements. The Intake Secretary will then set up an intake appointment. It may not be for several weeks, as there are often long waiting lists.
The intake appointment involves completing paperwork and arranging for payment. Members of HMO’s need referrals from the primary care physician if services are to be covered.
The intake interview with a therapist takes from one to one and a half hours. The therapist may be from any discipline. The therapist will ask detailed questions about the reason for the visit, as well as some medical questions. Consent forms are signed at this initial session.
Depending on the nature and severity of the problem, a second appointment is scheduled. It can be a continuation of the intake process or the beginning of treatment. Treatment can take many forms including medication evaluation, individual, group, family or marital counseling. It may involve a weekly appointment or attendance at a day program, which emphasizes socialization skills, life skills and possibly vocational or educational training. Treatment is determined by your needs and the agency’s philosophy. Clients have the right, at all times, to ask questions about the treatment that is being prescribed.
The ideal situation is when both therapist and client agree that the client has reached his/her goals. The therapist might suggest that the client become involved in a self-help group, a volunteer job or other social activity to help maintain the progress that has been made.
Sometimes, the relationship ends sooner than the client wishes. If the therapist terminates the relationship due to a work issue, the client may wish to suggest a meeting with both the old and the new therapist so that all three can discuss past progress and future goals.
If the client and therapist disagree on when to stop treatment, the issue should be openly discussed. The therapist should be asked to develop a plan so the client feels supported in daily life once therapy stops. Most therapists end a relationship by letting clients know that they are welcome to return if the need arises either for a brief visit or for future therapy.