PSYCHIATRIC UNITS IN GENERAL HOSPITALS: BOON OR BANE?
HERBERT C. SCHULBERG PH.D.1
1 NIMH Postdoctoral fellow in Community Mental Health, Harvard School of Public Health, Boston, Mass.
An attempt has been made to point to some of the major issues which are now affecting the development of psychiatric units in general hospitals. Although considerable attention has been given else-where to the popularity which these units have attained and to the values they supposedly hold, virtually no effort has been made to assess objectively their optimal role in the total range of mental health services. As a start, some specific suggestions have been made regarding data which are necessary to compare the efficacy of psychiatric units in relation to other existing treatment centers. This problem is most complex because of the covert and overt selection processes which are employed by the psychiatric units, in terms of both their staff recruitment and patient admission policies.
The urgent need to provide some meaningful, objective answer to the question of "What is the optimal role of the general hospital's psychiatric unit?" can be seen in the growing tendency of some states to reduce public support for their state hospital programs in favor of the former. One must sincerely wonder whether it makes any more sense at this time to invest all of our resources in the development of these psychiatric units than it did 30 years ago to place a similar emphasis upon the construction of large remote mental hospitals. "The fact that a given plan is an improvement over the status quo does not automatically establish it as the best possible plan"(39).
