THE PSYCHIATRIC INPATIENT UNIT IN A GENERAL HOSPITAL: A FUNCTIONAL ANALYSIS

The establishment of psychiatric units in general hospitals is widely regarded as one of the more important developments to have taken place in psychiatry in the last 15 years. The number of these units and of psychiatric patients admitted to general hospitals is constantly increasing.

Much has been written on the significance of this phenomenon but detailed studies of the function of any one of these units have been scarce and incomplete.

What kind of patients are most frequently treated in this type of service? What is their composition as to age, sex and clinical diagnosis? What is the average length of stay? What is their response to treatment? What is the ratio between patients referred from other hospital departments and patients directly admitted to the psychiatric service?

Our study is an attempt to answer these and other questions through a detailed investigation of the functioning of the psychiatric inpatient unit of a large metropolitan hospital, namely, the Mount Sinai Hospital of New York.

The 1,264 records of admissions to this service between 1947 and 1957 were individually examined and the extracted data placed on computer cards. Thirty-two percent of the patients were male and 68 percent were female. Sixty-seven percent of the patients were between the ages of 20 and 49. The median length of stay was approximately 50 days, with as many as 44 percent of the patients being discharged within one month from date of admission.

The relatively short period of hospitalization when compared with the length of stay of patients in mental hospitals indicates the primary therapeutic and rehabilitative function of this type of service, with fairly rapid restitution to the community of patients in improved condition. Only eight percent of the patients had to be transferred to other institutions for long-term care and 60 percent of the patients were discharged as improved. The role played by selectivity of patients in this regard is discussed.

The majority of the patients (63 percent) had a history of chronic mental illness.

A study of the sources of admissions showed that 65 percent of the patients were directly admitted and 35 percent referred from other hospital services. There has been, however, a marked change in the pattern of admissions over the years, the percentage of patients referred from within the hospital becoming increasingly smaller and that of patients directly admitted to the psychiatric service increasingly higher. The possible reasons for this change, namely, an evolving concept about "psychosomatic" illness and the effect of the liaison service, are considered.

The proportions of patients with physical illness (68 percent), and of patients on whom medical, surgical and other consultations were performed (56 percent), give a concrete illustration of the close interrelationship between our service and other services in the general hospital. The assignment of an attending physician on the medical staff to the psychiatric ward and the diversified function of the psychiatric liaison service are other significant aspects illustrating the full integration of psychiatry into the general hospital.

Incidental to our main purposes were findings deriving from the longitudinal character of our study, which have a specific bearing on increased knowledge of certain nosological entities and on the importance of the clinical record as a research tool.