Acute Psych Facilities - All the Same?

[NurseJJ09]

I have been a psych nurse for just a short time. Just wondering, in your experience, are acute psych facilities all the same. I've heard some references that some hospitals will take patients that no other facilities will take (I'm assuming this refers to the very aggressive patient.) Are there really facilities out there that will be more selective in the "type" of patients they accept.

It seems that these "more aggressive" patients come from facilities that will no longer take them back. These patients then get caught up in an acute hospital until they are accepted into a state hospital which can take months. In the meantime, these patients sometimes become more aggressive during their hospital admission. It seems to me that these are the patients that present a danger in the acute psych setting.

[diawc]

No, all facilities are not the same

Some are "for profit" some are not. Facilities can be selective, based on what type of programming is available. The really agressive patients do end up going to state facililties, because of the degree of violence they posess. Not all places can take violent patients.

Some places are free-standing, some are attached to the hospital.

[7student7]

I know my hospital takes some truly awful patients (we're a state hospital). I've only ever heard of one patient being banned. Some aren't admitted because they're not sick enough, but that's a different story. But even we are supposedly a little bit specialized. We're not supposed to take long term head injuries or dementia, but being the state hospital we do sometimes get stuck with those patients for a long while due to placement issues. But yes, every personal care home, nursing home and hospital-attached psych unit in our area sends undesirable patients to us. Not just violence, but annoying or manipulative patients that other places refuse to admit get sent to us. I'm not sure we're even allowed to turn anyone within a certain criteria away. I've heard we're not supposed to get super-violent felons, but we do occasionally.

[Davey Do]

NurseJJ09:

Interesting discussion. In these times of whim and woe, and a lot of so-called self-pay patients, and lawsuits up the wazoo, it's interesting that any facility would deny services to any benefit-endowed prospective patient.

However, to answer your question, even our State Facility has refused transfers. I heard that one refusal, for example, was due to some minor medical sitaution the potential transfer suffered from. This patient was a real hellcat, too. Oh well, what can you do?

I worked for the State Hospital back in the early 90's. It was, at that time, both a Civil and Forensic Facility. Since then, they've virtually closed the Civil side. It's mainly Forensics, now. Back when they closed down the Civil side, the plan was for the State to farm out those patients to the Community Hospitals. Then the State would reimburse the Community Hospital. However, the State now has no money. Hence, those patients are now self-pay with no benefits.

So, we deal with all kinds. As long as there is an open bed, we accept the patient. And if they become too much of a behavior problem, we may try to tranfer them to the State Facility. But, usually, we just have to deal with them. Nothin' else we can do.

But, hey, NurseJJ09- thanks for askin'.

Dave