Consecutive patient failures in an emergency residential alternative to psychiatric hospitalization are studied. Failure is defined as transfer from the alternative program to hospital inpatient care. Discriminant function analysis is employed to differentiate the failures from a sample of patients who were maintained and treated in the alternative program. The perceptions of the emergency housing program staff about the failures augment quantified results. Findings suggest that the failures can be distinguished from the comparison group. A variety of drug abuse and medication noncompliance problems are the strongest predictors of failure. Practice implications are discussed.

This investigation addresses two issues central to psychiatric hospitalization: (1) Can alternative treatments be effective? and (2) How can patients appropriate for the alternatives be identified? This random design study found that a majority of patients assessed as requiring immediate psychiatric hospitalization could utilize a combination of emergency housing and outpatient treatment to avoid hospitalization. Five key variables examined at intake proved useful in predicting ability to succeed in the alternative treatment setting. Patients who failed in the alternative setting had trouble utilizing leisure time, were grandiose, exhibited eating problems, had difficulty with family, and showed an absence of paranoia.

No abstract

The psychiatric emergency service can provide rich training opportunities for social work students. It is a site where they can learn to function in clinically autonomous, independent roles as primary care providers who are responsible for the evaluation, treatment, and disposition of psychiatric emergencies. Assuming responsibility for evaluating and intervening with a wide variety of people in acute distress prepares the student to enter professional practice with self-confidence. The abundant educational opportunities available on the psychiatric emergency service are discussed, teaching strategies to facilitate learning are suggested, and the unique professional growth experiences which derive from training are identified.