Influence of adults, clinicians, and environments upn type of psychiatric hospitalization

The purpose of this research was to investigate the complex process surrounding the community psychiatric hospitalization of adults by identifying the variables of statistical and practical significance that impact the decision. Facing increased fiscal constraints and limited human service resources within the public mental health system of care, this research presents opportunities to impact these problem areas.

By focusing on the setting where the clinical assessments occur, and the characteristics of the adults and clinicians, the research utilizes complexity theory as an organizing framework that lends order to the decision-making process leading to the hospitalization. Unmet needs verbalized by the adults and documented by the clinicians were frequently presented as barriers to community success, and are consistent with the literature as a predisposing factor related to care seeking within higher levels of care.

Utilizing a sample of 1724 adults who were hospitalized in community psychiatric facilities during the time period of 7/1/05 to 6/30/06, and 43 of the 59 clinicians who completed the assessments preceding the admission, the statistically significant predictor variables of age, symptom manifestation, and diagnosis were identified. As access to in-patient care was investigated, in addition to the complex interactions among the identified predictor variables, these three categorical variables take on additional practical significance. Connecting symptom manifestation and provisional diagnostic assignment to the objectivity, knowledge, and decision-making capability of the individual clinician, attempts are presented to break the repetitive cycle of adults presenting after hours to emergency departments to secure in-patient hospitalization.