A Case-Based Approach to State Hospital Psychiatry

Abstract

A Case-Based Approach to State Hospital Psychiatry is an introduction to modern-day state hospitals and to treatment and discharge planning within them. The book is composed of cases of fictional patients with varied diagnoses along with discussions to inform and guide clinicians. Cases illustrate points made in discussions and aim to describe patients’ experience of illness and treatment and their struggles for both relationships and independence. Though state hospitals vary in different places and times, cases illustrate how they can function. State hospitals can serve patients in ways other treatment settings cannot. Compared to community hospitals, their patients are more likely to be seriously and chronically mentally ill, treatment-refractory, and with a history of involvement in the criminal justice system. With a longer length of stay they can provide intensive treatment and discharge planning as well as containment and asylum. Discussions address the legal requirements and constraints of practice in this setting. Others review factors associated with medication nonadherence, rates of short-term symptom response and remission with most antipsychotic drugs, the multiple possible benefits of clozapine, and the relationship between childhood maltreatment and adult psychiatric disorders. Discharge planning means finding the best possible fit between an individual’s needs and risks and available housing and services in the community. Chapters focus on risk assessment, including risk factors for violence, risk management, the prevalence of criminal justice involvement in adults treated in state facilities, and the prevalence of serious mental illness in adults who are incarcerated.