THE PSYCHIATRIC EMERGENCY CLINIC: A FLEXIBLE WAY OF MEETING COMMUNITY MENTAL HEALTH NEEDS
M. DONALD COLEMAN M.D., and
ISRAEL ZWERLING M.D., PH.D.1
1 Department of Psychiatry, Albert Einstein School of Medicine, Bronx Municipal Hospital Center, N. Y.
An emergency psychiatric clinic has been established at the Bronx Muncipal Hospital in which patients are seen on a 24-hour basis and which offers immediate treatment as well as referral. The objective of this clinic has been to reduce the barriers between patient and psychiatrist by making it as easy as possible to see a psychiatrist at the time he is most needed. We feel this type of clinic offers a more flexible approach to psychiatric problems than is possible in most existing outpatient departments where therapy is too often determined by the clinic structure rather than the patient's needs.
The major areas where this clinic can be of unique help are discussed, with particular emphasis on emergency psychotherapy. This is a form of brief therapy instituted immediately in many acute neurotic and psychotic decompensations. Here is an area which the traditional psychiatric outpatient clinic ignores, overlooking the possibility that the therapeutic rewards for prompt and appropriate intervention may be greater at the moment of crisis than at any time thereafter when the patient is totally decompensated and perhaps hospitalized.
The techniques by which we attempt to restore the previously existing defensive structures of our patients have been discussed. These techniques are constantly evolving. While our experience confirms the original assumption about the value of emergency psychotherapy and the efficacy of some of our therapeutic techniques, we are aware that the problem of proper scientific evaluation will be with us for many years to come. Complicating our evaluation will be our definite impression that there are many more cases of acute neurotic and psychotic decompensation in the community than we had previously thought, and many are resolved without recourse to a doctor. If this last observation is correct, it opens to us some interesting questions about the resources these patients use in themselves or others to promote their return to their previous level of functioning.
This type of clinic allows great flexibility in providing follow up care where continuous patient-doctor contact, however brief or intermittent, is helpful. Many cases of chronic ambulatory schizophrenia fall into this category and their ability to live in the community is reinforced in many ways by caring for them in a program which is geared to their changing needs rather than the clinic administrative set up.
We also help to "back stop" the community social service agencies by providing immediate consultations for their emergencies, thereby extending the social agencies' willingness to cope with a broader range of community mental health problems.
Because we are able to offer a wide variety of immediate outpatient help, we find it is not necessary to refer as many patients to long term psychotherapy. We now have a very small waiting list for such treatment.
The organization of our emergency psychiatric service is adaptable to other large psychiatric outpatient organizations. We feel that it merits adoption because it more closely fits the varying needs of many types of patients and tends to meet these needs at the optimal time.
