THE TEXTBOOK OF HOSPITAL PSYCHIATRY
“The Textbook of Hospital Psychiatry,” edited by Steven S. Sharfstein, M.D., M.P.A; Faith B. Dickerson, Ph.D., M.P.H; and John Oldham, M.D., M.S., and recently published by American Psychiatric Publishing, Inc., is the first comprehensive guide to hospital psychiatry to be published in more than a decade. It’s a compilation of the latest trends, issues and developments in the field. The textbook, written by 70 national experts and clinical specialists, covers a wide range of clinical and administrative topics that are central to hospital psychiatric practice today.
John S. McIntyre, M.D., Clinical Professor of Psychiatry, University of Rochester, Rochester, New York, was quoted in a book review for the Journal of Nervous and Mental Disease (Volume 197, Number 9, September 2009) as saying “This textbook is a gem. Anyone involved in an inpatient unit or interested in learning more about what happens in 21st century psychiatric inpatient units should read this book. I commend the editors on this contribution to our field.”
The more than 500 page book contains 35 chapters divided into four main sections: Part I: “Inpatient Practice;” Part II: “Special Clinical Issues;” Part III: “Continuum of Care;” and Part IV: “Structure and Infrastructure.” Highlighted here are snapshots of a number of key chapters.
n Chapter 16: “From Within: A Consumer Perspective on Psychiatric Hospitals,” by Lisa J. Halpern, M.P.P; Howard D. Trachtman, B.S., C.P.S.; and Kenneth S. Duckworth, M.D. One of the most compelling chapters in the book, this section has been highlighted in numerous reviews of the text. The authors provide their first hand experience of a psychiatric hospital stay from the patient’s perspective, and describe the often frightening and bewildering experience of being confined on an inpatient hospital unit. The authors note that hospital stays are likely to improve as the concept of recovery is applied in the hospital setting and as hospital staff convey the new sense of optimism and hope about serious mental illness. Hospital stays are also improved by the direct involvement of consumers in hospital care.
n Chapter 18: “Improving Safety in Mental Health Treatment Settings: Preventing Conflict, Violence, and Use of Seclusion and Restraint,” by Kevin Ann Husckshorn, R.N., M.S.N, C.A.P., I.C.A.D.C, and Janice L. LeBel, Ph.D. This chapter describes another of the latest trends in hospital practice and outlines strategies to prevent conflict, violence and use of seclusion and restraint. The writers underscore the importance of training staff on tools and strategies to prevent the use of seclusion and restraint. The authors note the benefits of creating alternative and less intrusive strategies to replace physical containment. They also emphasize the importance of including consumers and advocates in planning and implementing such a program.
n Chapter 19: “Inpatient Suicide: Risk Assessment and Prevention,” by Robert P. Roca, M.D., M.P.H., M.B.A and Laurie Hurson. The authors discuss inpatient suicide and how this most adverse event may be prevented and present a review of suicide risk assessment instruments, including the suicide assessment and prevention tool that the authors have developed and implemented at Sheppard Pratt Health System. It is sobering to note that as many as 1,500 inpatient suicides may occur annually in psychiatric hospitals in the U.S., indicating that this problem deserves the highest attention.
n Chapter 26: “Administration and Leadership,” by Harold I. Schwartz, M.D. and Steven S. Sharfstein, M.D., M.P.A. The authors review the core components of successful psychiatric hospital administration and the complex issues of the internal organization and external marketplace. The authors stress that the challenges faced by psychiatric hospital leadership are only likely to intensify as the corporatization and commercialization of health care continue. Increasingly competitive and market-driven, psychiatric hospital systems will be challenged to reduce operating costs, while maintaining their quality of care. Additionally, hospitals will need to accomplish all of this while integrating new and evolving technologies for both diagnosis and treatment.
n Chapter 33: “The Electronic Medical Record,” by John J. Boronow, M.D. This chapter examines one of these evolving technologies, the electronic medical record (EMR). While the myriad problems of paper records are widely known, how to institute an electronic substitute has been a major challenge for psychiatric institutions. In this cutting-edge chapter, the author describes the many advantages of the EMR including the development of a problem list readily linked to clinical documentation by all disciplines involved in the patient’s care. The EMR also allows for updated documents and may include relevant data in summary display. Boronow notes that the EMR facilitates a better integration of clinical components as well as more documentation of behavioral tracking. And these features can be achieved with adequate protection of patient privacy, which is often a concern about EMRs. Unfortunately, development of EMR systems are still in a relatively nascent state.
n Chapter 35: “Hospital Psychiatry for the Future,” by Steven S. Sharfstein, M.D., M.P.A. In this final chapter, Sharfstein builds on the theme that, despite the major changes in hospital psychiatry that have taken place in past 100 years, and the rapid changes in the past 10, that the field of hospital psychiatry is here to stay. He notes 21st Century trends in psychiatric hospitalization, including the increasing specialization within psychiatry, the emphasis on recovery, the continuing rapid development of biological and somatic interventions, and the increasing partnership between psychiatric treatment with the rest of medicine.
“The Textbook of Hospital Psychiatry” provides invaluable information for both psychiatric hospital clinicians and administrators in a single, all-inclusive volume. The text is inclusive of the many roles of hospital psychiatry and programs that serve people across the life span. Expert contributors highlight the emergence of units that focus on specific diagnoses and age groups; such as units for child, adolescent and geriatric patients; as well as units that provide specialized care for highly complex subgroups, such as eating disorders, trauma disorders and co-occurring alcohol and substance abuse disorders. Additionally, the book covers a variety of cutting-edge issues such as safety improvement, suicide prevention, and culturally competent psychiatric care.
Chapter summaries prepared by Faith Dickerson, Ph.D.
The textbook can be ordered online at www.appi.org/book or Amazon.com for $135