Psychiatric Annals

ADULT PSYCHIATRIC AMBULATORY CARE SERVICE

Austin Moore, MD

Abstract

From 1970 to 1972, the Adult Outpatient Clinic was reorganized with the intent of rebuilding morale and again providing the regular, ongoing care which had been disrupted by the sit-in. An appointment system was reinstituted, more group treatment methods were utilized in view of the numerical paucity and clinical skills of remaining staff in all disciplines. Mental health assistants were brought into the clinic to expand the treatment possibilities, and more supervision was given in determining a treatment plan for patients. The structure developed permitted more effective coordination of treatment, as well as more efficient use of staff, and has resulted in increased ability to provide the continuity of care for initially ambulatory patients, which had already become possible for those admitted first as inpatients.

A socialization unit led by the clinic coordinator, a nurse with a master's degree in community mental health, was started in 1971 to offer care, which consisted of daily group meetings, to patients who were, in general, chronically mentally ill, with little diversion and minimal contact with their environment. The unit has progressed and now not only offers socialization, but has become a step toward rehabilitation.

Many chronically ill patients from other divisions of the Department of Psychiatry are treated in what is now called The Activities of Daily Living Program as a kind of outpatient halfway program, with transfer to the Division of Rehabilitation as its goal. The program is staffed by two paraprofessionals, recruited from The Women's Talent Corps and trained at Harlem Hospital Center, who work under the close supervision of the Department's Chief of Activity Therapy, a highly trained and skilled occupational therapist. A senior psychiatrist on the clinic staff consults regularly with staff and conducts weekly group meetings of patients.

There is a great need for comprehensive psychiatric care for geriatric patients throughout the United States; however, this need is probably greatest in the Northeast, and within that area, there is no locality where geriatric patients suffer more than in New York City. It is a densely populated city with a style of living that includes many elderly persons on fixed incomes and large numbers of elderly persons living in single rooms. There is often a disruption of family life with the elderly being only in marginal contact with relatives. A massive bureaucratic structure exists through which few of the elderly can forge in order to obtain proper medical care or assert their rights.

The above characteristics of the city predispose to worsening and complication of any psychiatric geriatric problems, while at the same time making treatment of the problems extremely difficult. For these reasons, a comprehensive geriatric psychiatric day care unit, with (acuities for medical, social and psychiatric care, was started at Harlem Hospital Center in 1973. It was based on the experience with a therapeutic group for geriatric patients initiated much earlier by a senior social worker in the clinic and our community mental health nurse.

Currently, the Adult Ambulatory Services consist of the Adult Outpatient Clinic, Emergency Room, Ward Consultation Services, Activities of Daily Living Program and the Geriatric Program. The objective is to eventually mold together all the units, with some more tightly connected than others, so that all resources are pooled and easy access given to all units. This will lead to the most efficient use of staff and distribute talents in such a way that they are made available to all and deficiencies can be corrected for all. Conceptually, this is fine; the question is, can it be made to work? At Harlem Hospital Center we are attempting to find the answer to this…

From 1970 to 1972, the Adult Outpatient Clinic was reorganized with the intent of rebuilding morale and again providing the regular, ongoing care which had been disrupted by the sit-in. An appointment system was reinstituted, more group treatment methods were utilized in view of the numerical paucity and clinical skills of remaining staff in all disciplines. Mental health assistants were brought into the clinic to expand the treatment possibilities, and more supervision was given in determining a treatment plan for patients. The structure developed permitted more effective coordination of treatment, as well as more efficient use of staff, and has resulted in increased ability to provide the continuity of care for initially ambulatory patients, which had already become possible for those admitted first as inpatients.

A socialization unit led by the clinic coordinator, a nurse with a master's degree in community mental health, was started in 1971 to offer care, which consisted of daily group meetings, to patients who were, in general, chronically mentally ill, with little diversion and minimal contact with their environment. The unit has progressed and now not only offers socialization, but has become a step toward rehabilitation.

Many chronically ill patients from other divisions of the Department of Psychiatry are treated in what is now called The Activities of Daily Living Program as a kind of outpatient halfway program, with transfer to the Division of Rehabilitation as its goal. The program is staffed by two paraprofessionals, recruited from The Women's Talent Corps and trained at Harlem Hospital Center, who work under the close supervision of the Department's Chief of Activity Therapy, a highly trained and skilled occupational therapist. A senior psychiatrist on the clinic staff consults regularly with staff and conducts weekly group meetings of patients.

There is a great need for comprehensive psychiatric care for geriatric patients throughout the United States; however, this need is probably greatest in the Northeast, and within that area, there is no locality where geriatric patients suffer more than in New York City. It is a densely populated city with a style of living that includes many elderly persons on fixed incomes and large numbers of elderly persons living in single rooms. There is often a disruption of family life with the elderly being only in marginal contact with relatives. A massive bureaucratic structure exists through which few of the elderly can forge in order to obtain proper medical care or assert their rights.

The above characteristics of the city predispose to worsening and complication of any psychiatric geriatric problems, while at the same time making treatment of the problems extremely difficult. For these reasons, a comprehensive geriatric psychiatric day care unit, with (acuities for medical, social and psychiatric care, was started at Harlem Hospital Center in 1973. It was based on the experience with a therapeutic group for geriatric patients initiated much earlier by a senior social worker in the clinic and our community mental health nurse.

Currently, the Adult Ambulatory Services consist of the Adult Outpatient Clinic, Emergency Room, Ward Consultation Services, Activities of Daily Living Program and the Geriatric Program. The objective is to eventually mold together all the units, with some more tightly connected than others, so that all resources are pooled and easy access given to all units. This will lead to the most efficient use of staff and distribute talents in such a way that they are made available to all and deficiencies can be corrected for all. Conceptually, this is fine; the question is, can it be made to work? At Harlem Hospital Center we are attempting to find the answer to this intriguing question. This is of great importance in inner city hospitals where staff is always limited; therefore, the very best must be done with what one has, if the goal is excellent care.

10.3928/0048-5713-19740501-05

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