title: Trends in acute mental health care: comparing psychiatric and substance abuse treatment programs.
abstract: This study compared psychiatric and substance abuse acute care programs, within both inpatient and residential modalities of care, on organization and staffing, clinical management practices and policies, and services and activities. A total of 412 (95% of those eligible) Department of Veterans Affairs' programs were surveyed nationwide. Some 40% to 50% of patients in psychiatric and substance abuse programs, in both inpatient and residential venues of care, had dual diagnoses. Even though psychiatric programs had a sicker patient population, they provided fewer services, including basic components of integrated programs, than substance abuse programs did. Findings also showed that there is a strong emphasis on the use of clinical practice guidelines, performance monitoring, and obtaining client satisfaction and outcome data in mental health programs. The author's suggest how psychiatric programs might better meet the needs of acutely ill and dually diagnosed patients (e.g., by incorporating former patients as role models and mutual help groups, as substance abuse programs do; and by having policies that balance patient choice with program demand).
authors.affiliation: VA Palo Alto Health Care System, Center for Health Care Evaluation, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. ctimko@stanford.edu
authors.forename: Christine
authors.initials: C
authors.lastname: Timko
authors.forename: Michelle
authors.initials: M
authors.lastname: Lesar
authors.forename: Noël J
authors.initials: NJ
authors.lastname: Calvi
authors.forename: Rudolf H
authors.initials: RH
authors.lastname: Moos
mesh_terms: D000208:Acute Disease; D017831:Diagnosis, Dual (Psychiatry); D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data / Q000639:trends; D016134:Organizational Policy; D017060:Patient Satisfaction; D010561:Personnel Staffing and Scheduling; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011567:Psychiatric Department, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D012114:Residential Treatment / Q000639:trends; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D014481:United States; D014493:United States Department of Veterans Affairs