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By: Dr. Luis J. Rivera Rivera, MD, DABPN
FHC Medical Director

Working with psychiatric patients at a general care hospital can be challenging for healthcare professionals, as it requires a specialized approach that must consider the patient’s mental and physical healthcare needs. Therefore, It’s important to recognize the symptoms of mental health problems early on, in order to provide the appropriate treatment to prevent the condition from getting worse.

The most relevant aspects in managing patients with mental health conditions at a general care hospital include:

1. Early identification
2. Safety
3. Pharmacological and non-pharmacological treatments
4. Communication and education
5. Collaborative care
6. Finally but equally important, discharge planning

The first step in managing mental health problems is detection.

• Therefore, early identification of psychiatric symptoms is essential for effective management
• Healthcare professionals must be trained to recognize the signs and symptoms of psychiatric conditions, such as anxiety, depression and delirium.
• Screening tools, such as the PHQ-9, can also help identify patients with psychiatric symptoms early on, while screening for substance use disorders are important as well, given that this issue can influence the progress of both mental and physical conditions.

Likewise, patient and staff safety is also a priority when managing psychiatric symptoms at a general care facility, as patients with psychiatric symptoms may be at risk of self-harm or aggression.

• Therefore, appropriate measures must be taken to ensure patient safety
• This may include close monitoring, physical restrictions, or the use of sedatives when needed.
• Hospital personnel should also be trained in de-escalation techniques to prevent and handle potentially dangerous situations.

Drugs may be an effective treatment option for psychiatric symptoms at the hospital.

• Healthcare professionals should prescribe them as established in the evidence and monitor patients closely to ensure the drug is effective and tolerated well.
• Patients must also be educated regarding the possible side effects of any drug, as well as motivated to report any adverse reactions.
• A patient’s response to a drug must be monitored regularly, with any side effects addressed promptly
• Also, the patient’s drug regimen must be reviewed regularly to ensure it remains appropriate.

Non-pharmacological interventions may also be effective in controlling psychiatric symptoms at a general care hospital.

• These interventions may include cognitive behavioral therapy, relaxation techniques, designated quiet spaces in the hospital, and aromatherapy
• Environmental modifications may also be considered to reduce sensory overload
• Decreasing noise levels, reducing the impact of lighting, and providing sensory aids such as noise-cancelling headphones or weighted blankets may help patients with psychiatric symptoms regulate their sensory load.
• Sensory aids can also provide a sense of comfort and security, which in turn can help patients feel more in control of their surroundings.

Communication with patients, their families and healthcare professionals is key

• Effective communication is also essential when managing psychiatric patients. This means providing them with clear and concise information about their condition, treatment options and expected outcomes. The patient’s family and caregivers should also be involved in the treatment process, with their opinions taken into consideration when making decisions about the patient’s care.

Collaborative care, which is another of the most relevant aspects when managing patients with mental health conditions, involves working with multiple healthcare professionals to provide comprehensive care to patients with mental health problems.

• Collaboration among professionals is essential for the effective management of psychiatric symptoms at a general care hospital. If the hospital has mental health professionals, they should become involved in the patient’s care early on, working closely with the physical healthcare team to develop a comprehensive treatment plan that addresses all of the patient’s needs. The hospital should consider having consulting specialists who can be part of the collaborative team, given that collaborative care can improve treatment outcomes and reduce the risk of relapse.
• In the event a patient presents dangerous symptoms, such as suicidal thoughts, homicidal ideas, severe mania and disorganized thoughts and behavior (ruling out that it’s not caused by delirium) that could endanger the safety of the patient and others, the patient must receive in-hospital treatment. This clinical scenario is preferably managed at a psychiatric hospital, with patients transferred from the general care hospital if necessary. Although this type of coordination can be handled directly between the general care and psychiatric hospitals, the hospital in charge has the organizational resources to manage the patient’s healthcare coverage. The patient’s caregiver can communicate directly with the plan for assistance.

Discharge planning is an essential component when managing psychiatric symptoms at a general care hospital, and should begin early in the hospitalization process.

• The hospital’s clinical team must work with the patient and the family or caregiver to develop a plan that considers any ongoing needs, including drug administration, follow-up appointments and community support services. If the patient needs to be referred for mental health services, it’s very important to discuss this with the individual, and explain how the referral and coordination process will be handled. The patient’s discharge plan must be clearly communicated to all parties involved, and arrangements must be made before the patient is discharged from the hospital.

Although working with a psychiatric patient at a general care hospital can be challenging for healthcare professionals, we have the ability to address this need in a satisfactory manner. Comprehensive clinical examinations and timely management that involve the collaboration of professionals, along with the integration of family members and post-discharge care planning are tools within reach of what we know and are able to offer patients to promote their physical and emotional well-being.

Referencias:

1. American Psychiatric Association. (2019). Practice guideline for the psychiatric evaluation of adults
2. Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., & Gask, L. (2012). Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews, 10, CD006525. doi: 10.1002/14651858.CD006525.pub2
3. Joint Commission. (2018). Comprehensive Accreditation Manual for Hospitals. Joint Commission Resources
4. National Alliance on Mental Illness. (2021). Hospitalization: Getting Treatment During a Crisis. https://www.nami.org/About-Mental-Illness/Treatment/Getting-Treatment-During-a-Cr isis