AN INPATIENT PSYCHIATRIC SERVICE FOR CHILDREN IN THE TEACHING HOSPITAL
REYNOLD A. JENSEN M. D.1, and
DENTON P. ENGSTROM M. D.2
1 Professor of Psychiatry and Pediatrics, at the University of Minnesota Medical School and University Hospitals, Minneapolis, Minn.
2 Instructor of Psychiatry and Pediatrics, at the University of Minnesota Medical School and University Hospitals, Minneapolis, Minn.
Careful review of our experience to date leads us to conclude:
1. An inpatient psychiatric service for children in a teaching hospital, which provides care for a small group of children with behavior disturbances, serves usefully in the teaching program. Likewise, it eases the demands on the other inpatient services, as well as relieves them in case of need.
2. It should be modest in size—preferably 20 beds.
3. Ideally, the maximum age range should not extend beyond 14 years with some flexibility permitted in the individual case.
4. Sex ratio to be expected is 2 males to 1 female.
5. Expected ratio of staff to patient is approximately one to one for each 8-hour period during the day. Staff personnel should include nurses, nurses' aides, psychiatric attendants, occupational therapists, and a school teacher well-trained in remedial teaching methods.
6. If selected with care, children of all ages can be admitted. It has been noted that problems of management are eased when there is a dispersion in age range of the patients.
7. For effective operation, ample space is required for adequate program planning and management.
8. Good interdepartmental relations with all other departments, but more particularly with pediatrics and psychiatry, are essential.
9. It is rarely advisable to arrange a direct admission from the juvenile court, since both patient and family then tend to identify the hospital unfavorably with the court.
10. Admission of hostile, "acting out" aggressive adolescent delinquents is rarely feasible for obvious reasons.
11. Continuous attention to the improving and strengthening of staff integration is essential for smooth and effective operations.
12. A small, adequately staffed outpatient service is an essential complementary unit to the inpatient service, in order to provide adequate screening of patients, to provide follow-up treatment for some inpatients upon discharge from the hospital, and an ample supply of case material for teaching and research purposes. It should not be expected to provide comprehensive service to local communities.
