Many healthcare institutions in the world assist people with mental health problems. However, not all of them bring real benefits and work effectively due to inadequacies in management and treatment approaches. However, the use of case management can facilitate the development of such facilities and help patients. Consequently, this paper will provide a short description of a psychiatric hospital by analyzing the treatment of major depressive disorder to demonstrate the strength of case management for operating healthcare facilities.
Depression as Major Mental Health Problem
Depression is one of the most common significant mental problems. The danger of this diagnosis is that it can occur at any age and in any person, regardless of gender, religion, or socioeconomic status. Although depression often occurs due to traumatic events, it can also develop without obvious reasons (“Major depression,” 2018). For this reason, a significant portion of the population is not diagnosed with this disorder due to the lack of resources or temporary manifestations of symptoms. The prevention and diagnosis of depression became especially relevant during the COVID-19 pandemic, as in 2020, the number of people who reported symptoms of depression tripled (27.8%) (Van Beusecom, 2020). Consequently, this problem is relevant for a quarter of the US population and needs to be addressed.
In most cases, people with depression, or major depressive disorder, receive care in outpatient hospitals and clinics. However, these patients are more likely to experience mild depression with mood changes and frustrating thoughts that do not interfere with normal functioning and safety. Nevertheless, severe depression threatens people’s lives because they lose interest in work, hobbies, loved ones, experience a lack of strength, which leads to weight loss, inability to take care of themselves, self-harm, and suicide. At the same time, although not all people with depressive disorder commit suicide, its likelihood increases by 2-6% depending on the severity of symptoms (“Does depression,” n.d.). In addition, depression can affect people’s thoughts and create hallucinations and illusions, and during periods of intense excitement or mania, they can be overly irritable, which can harm them or others (“Major depression,” 2018). In such cases, people require inpatient treatment for constant monitoring, prevention of self-harm attempts, and selection of appropriate treatment.
Safety of Patients
Psychiatric hospitals are designed for patients going through the acute phase of disease development to recover to the emotional and cognitive state necessary for independent living. For this reason, there are several safety concerns that hospital staff and administration face delivering services. These concerns include barriers to self-harm and suicides, falls, adverse medication events, and patients absconding.
Patients with severe depression are prone to suicidal thoughts and moods. For this reason, hospital protocols should contain preventive measures such as early detection and prediction of suicidal behavior, treatment and support, removal of dangerous items, and constant surveillance. Although the continuous observation of patients is controversial as it violates the privacy and confidentiality of patients, this measure is the most accessible and appropriate during periods of exacerbation of suicidal moods and allows interaction (Slemon et al., 2017). For example, a patient can walk around the hospital and engage in communication with other patients; however, personnel will react quickly in case of danger. During the period of symptom reduction, observation may decrease.
Hospital management protocols and staff requirements can address patient escapes and falls. First, the area of the institution must be safe for the free movement of patients and staff; for example, it should not have slippery floors or stairs. Second, the leading causes of patient absconding are boredom, lack of communication, and negative staff attitudes that make patients feel lonely and deprived of dignity (Brickell et al., 2009). For this reason, offering leisure options such as a library, games, art activities, encouraging communication, and requiring staff to treat patients with respect can reduce patients’ desire to leave hospitals without permission. In addition, a closed-door policy should be an additional security protocol to minimize the likelihood of accidental or unintentional leaving of the hospital.
Another critical aspect of safety is the prevention of errors in the dispensing of medicines and their safe storage. As Brickell et al. (2009) note, that although most often adverse medication events do not have harmful consequences, some of them brought severe outcomes. In addition, some patients can deliberately steal medicines from supplies to reduce symptoms or commit suicide. Therefore, the hospital should have protocols for the safe storage of medications in secure areas and check the compliance of the pills as prescribed by the doctors. Thus, although some of the methods described are controversial, they are necessary in cases where therapy has not yet yielded results or is ineffective.
Case Management and the Hospital Functioning
Treatment of mental illnesses, including depression, is a long and complex process that the hospital must consider in its daily care for patients. However, since psychiatric hospitals are designed for short stays, they cannot provide a full course of treatment independently. For this reason, the hospital will use the intensive case management (ICM) model to meet patient needs and improve their health outcomes.
ICM is a case management approach that focuses on team care of patients through the collaborative efforts of outpatient and inpatient workers. This model includes providing patients with medication, outpatient therapy, and home visits, as well as hospitalization (Morandi et al., 2017). Consequently, a team of professionals will serve inpatients and provide them with care, talking personal therapy, art therapy, and physical treatment as needed. Since ICM is usually aimed at a small group of patients, each of them will receive sufficient attention (Morandi et al., 2017). Once discharged, patients will also have access and support from outpatient specialists who will continue their treatment as part of the program. However, a hospital-based treatment option will also be available for those patients who are unwilling or unable to use ICM programs, although their care approach will also be team-based and integrated. Thus, such a case management model is essential for hospital operations, since it will reduce the length of hospital stays and readmissions, as well as promote positive treatment outcomes and patient satisfaction (Hangan, 2006). These results will improve the hospital’s reputation and hence the hospital’s profit.
The choice of therapies for the treatment of depression is critical to the counseling process and its outcomes and depends on the personal characteristics of a patient. For example, depressed patients can have different attitudes towards their condition if they decide to seek help or have been admitted to the hospital after harming themselves. In addition, understanding the causes of depression and prior history of treatment is also crucial as one practical method is not universal. For this reason, the psychiatric hospital will apply such approaches as cognitive-behavioral therapy and psychodynamic therapy.
Cognitive-behavioral therapy is one of the most common treatment approaches, which is based on the collaboration of the patient and the psychologist. Consequently, this approach is most suitable for patients who realize their problems and seek help. This approach is essential for the hospital as it is built on the basis of trust between the patient and the psychologist and, therefore, helps the patient better adapt to the conditions of a closed institution and move on the path to recovery (McLeod, 2013). In addition, this therapy allows the patient to develop coping with triggers that cause depression, such as social anxiety or low self-esteem, gradually and under supervision. For instance, therapeutic practices can include behavioral experiments, exposure techniques, and other methods (McLeod, 2013). Therefore, cognitive behavioral therapy essential to engage patients in communication and integration and avoid traumatic experiences that can worsen depression.
Psychodynamic therapy also requires patients to be open and willing to solve their problem; however, it seeks to identify the underlying problem. This method is necessary for those patients who do not understand their emotions that lead to depression and do not recognize its source, which is probably based on past experiences (McLeod, 2013). In addition, this method has its advantages for indigent patients and is necessary for short stays of patients in a psychiatric hospital. As McLeod (2013) noted, although brief therapy is often not an appropriate solution, the psychodynamic approach can achieve results in a small number of sessions. In addition, although the hospital stay is usually insufficient, the goal of the psychologist using this approach is to prepare the patient for further actions and responsibilities to continue treatment (McLeod, 2013). For indigent patients who may not be able to receive long-term care after discharge, this approach is essential to increase their likelihood of recovery.
Treating mental health is an expensive process, and the bills of an inpatient hospital stay can be significant. However, Medicaid covers inpatient care for people under 21 and over 65, and Medicare covers up to 190 days of inpatient care in a lifetime (“Inpatient mental,” n.d.; “Inpatient psychiatric,” n.d.). Therefore, this insurance should be sufficient to provide a short hospital stay as well as outpatient care. However, those people who do not have insurance are also more likely to need financial support as the ICM model requires community resources (Hangan, 2006). Consequently, national and state programs, charity organizations, and agencies will be of paramount importance for full or partial payment for services, as well as outpatient care after discharge. ICM depends on external resources as they are required to apply this approach for patient care.
Evaluation of Facility’s Effectiveness
The state of patients’ health can most efficiently and accurately measure the performance of psychiatric hospitals. Depression is most often a medical condition that can be treated. In other cases, psychiatric hospitals can decrease the manifestation of symptoms to make a patient’s life more comfortable. Therefore, an indicator of a patient’s mental health state should be the main one for assessing the performance of the psychiatric hospital.
More specifically, the treatment results can be evaluated by the assessment of an outpatient specialist who will consult the patient after discharge, feedback from his or her family and loved ones, and cases of readmission and suicide. According to research, patients who were treated in psychiatric hospitals were 4-6% more likely to commit suicide because their form of depression was severe (“Does depression,” n.d.). Consequently, the indicators of self-harm and suicide over 12 months after discharge are the data required for assessment. In addition, since most patients continue to consult with a counselor and take medication after discharge, the initial and subsequent evaluations of professionals will help to understand the effectiveness of inpatient treatment. The most positive indicator is the percentage of patients who have stopped taking medication and overcome symptoms of depression. Feedback from family or loved ones about patient behavior can also be a useful assessment tool as it usually demonstrates how patients actually feel before and after hospitalization. Thus, the initial results of assessing the mental health of patients after discharge and further observation of their mental state after 3, 6, 12 months will make it possible to evaluate the effectiveness of the hospital.
Therefore, an analysis of the literature on mental illnesses and case management of medical facilities demonstrates that depression is a significant problem for society, which requires an integrated approach to treatment. Depression is a disorder that everyone can face, which speaks to society’s vulnerability and the need to prepare for treatment for this problem. At the same time, even severe depression is treatable, and the effort to overcome its negative consequences gives society a healthy person who can benefit from its development. For this reason, mental hospitals need to use the intensive case management (ICM) model of case management and team approach to treating patients to achieve the most positive health outcomes. However, since this model is lengthy and involves many parties, community resources are critical aspects of its successful implementation.
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