State Facilities

[UKPedsRN]

Excuse my ignorance, but anyone working in a State facility help me out here. I am simply a UK peds nurse studying again. I am writing a paper on the differences between the US & other countries.

The only Psych I did was during my training - a 10 week rotation

My question is What is the difference between a State psych facility and psych unit in say a community hospital.

Are the patients long term, more acute or????

Again, I apoligise for my ignorance.

Thanks

[RN2begin]

I work in a state psychiatric facility. The difference between a state facility and an inpatient psych unit at a hospital is that an inpatient unit at a hospital can choose who they admit. A case is presented from an emergency (usually where a patient must present for evaluation before placement) to the hospital psychiatric unit, if they have one. Said unit can refuse admit based on acuity, past experience with this patient, lack of insurance (although the latter is rarely admitted to by unit MD). In addition, a patients stay is voluntary, they can sign themselves out AMA, or perhaps be IEA'd to a state hospital.

A state hospital, on the other hand, must take all who present to an ER and are deemed a threat to themselves or others, regardless of acuity, dx, past experiences and/or lack of insurance. State hospitals are also the only place where a patient can be admitted against their will, usually by IEA (involntary emergency admission). Said patients will see a judge within 3 business days. The judge will decide, based on knowlege provided by patient and of the petitioner of the IEA, whether the patient is truly a threat to self/others leading to continued confinement or if the threat to self/others is unfounded. In the latter case, the patient is released that day.

[elkpark]

I've found, in extensive experience with both over the years, that the biggest difference between state and community hospital psych facilities is the client's ability to pay for care -- whether the person has good insurance (or ample private funds) or not. Community hospital units can (and many do) refuse to admit people who need care simply because they aren't expected to be able to pay the bill (a radical concept to someone in the UK, I realize! :)) State facilities are the "last resort" for people on Medicaid or uninsured & indigent. They also tend to be the "last resort" for people who need long-term inpt. psych care, again largely because of funding issues.

The statement RN2begin made about people only being able to be involuntarily admitted to state facilities is not necessarily true. Commitment laws vary from state to state in the US; her (?) state may only permit involuntary admissions to state facilities, but my state does not. People are involuntarily admitted all the time to community hospital units in my state. If, at the client's hearing, s/he is committed for an extended length of time (more than a few days), community hospital units will often transfer the person to a state facility, again strictly because of $$$ concerns.