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 19th
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/

General practice of psychiatric institution (1)

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (17)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

General practice of psychiatric institution (1)