CLINICAL HANDBOOK OF SCHIZOPHRENIA

34. Emergency, Inpatient, and Residential Treatment 351due to worsening medical conditions. Patients may also be discharged to board and carehomes when they achieve a greater degree of medical and psychiatric stability.Nursing Homes/Skilled Nursing FacilitiesNursing homes, or skilled nursing facilities (SNFs), were designed for geriatric or chronicallymedically disabled patients; however, recently they have frequently been used forpatients with mental illness particularly as a way to facilitate discharges from state hospitals.Because these facilities were not developed for patients with psychiatric illnesses,these patients may face many problems when they go to a nursing home, because the staffis usually not prepared to cope with and to serve them appropriately. These nursinghomes may offer inadequate evaluations or limited psychiatric and psychological services(Sherrell, Anderson, & Buckwalter, 1998). Unfortunately, there appears to be little in theway of a plan to address these issues in the future.These services are normally provided by contractors, and currently there is little systematicplanning to provide services to the mentally ill. Often, there is no consistent evaluationand treatment plan, unless a family member or a staff member of the nursinghome requests that service of the facility (a task that generally falls on the social director).Although some SNFs have attempted to address these issues, if these facilities are to beused for the mentally ill, they will require better developed activity programs, greater psychiatricsupervision, and more consistent and thoughtful psychologically based care. Otherwise,patients may undergo psychiatric deterioration and worsening in social functioningand self-care.Therefore, SNFs are not appropriate facilities for the psychiatric patient, becausethey cannot provide the services needed for adequate treatment. Most SNFs will have toundergo a thorough restructuring to provide adequate services in terms of not only treatmentbut also rehabilitation and reintegration to society; this does not seem likely in thenear future.CONCLUDING THOUGHTSOur intention in this chapter has been to shed light on various ways clinicians can helppsychiatric patients who require assistance in critical moments of their lives to maintainclinical stability, or who need long-term inpatient or residential treatment to become fullyfunctioning human beings. In the past, clinical stability was often addressed by institutionalizingpatients and providing them with inpatient treatment. The facilities that providedthese treatments sometimes functioned more like prisons than hospitals, althoughthey were labeled as hospitals and had some hospital-like characteristics. Having an individualwith schizophrenia function and be productive in society was unimaginable, andthe word rehabilitation was not even in the psychiatric parlance. The advent ofdeinstitutionalization brought new dimensions to ways that we can help patients withschizophrenia not only attain greater stability and symptom improvement but also reclaimtheir position in society as people with significant contributions to make to societyas a whole.All the services discussed—inpatient, outpatient, and residential—are valuable intheir own ways if they are operated thoughtfully, without abuse, and with well-devisedplans. On the other hand, all services have their limitations; psychiatric patients who, inyears past, would have been routinely admitted to an inpatient unit are today often consideredfor residential facilities or even individual housing in communities with appropri-