CLINICAL HANDBOOK OF SCHIZOPHRENIA

352 V. SYSTEMS OF CAREate assistance. We also know that many psychiatric patients are placed in facilities thatare not appropriate for them, and that have no plan or personnel prepared to cope withthe complexity of services needed to care for psychiatric patients.As we have seen, our services to psychiatric patients are still far from optimal. However,the winds of change have touched this exciting field, and the momentum seems to begrowing. Improving the quality of services has created new opportunities. More researchshould be done to enhance psychiatric treatment and rehabilitation, and to help these patientsreceive the care they deserve. We anticipate that in the future the quality and effectivenessof inpatient and outpatient facilities will continue to improve. We also anticipatemore fluid boundaries between inpatient and outpatient facilities, so that patients canmove more efficiently from one facility to another depending on their needs and complexityof their cases. But we need more information to be able to advise families and patientsregarding the suitability of a facility based on the patients’ conditions.We trust that further research and efforts will result in a deeper understanding oftreatment options for schizophrenia and perhaps help to reduce the societal stigma associated with the condition. With this, we hope that people with serious psychiatric difficultieswill become less isolated in a society that is better able to integrate them as contributingmembers of the community at large.GeneralKEY POINTS• Remember that people requiring assistance in critical moments of their lives, such as duringa period of schizophrenia illness exacerbation, are very vulnerable and require a considerablefocus on sensitivity and confidentiality.• A strong and well-developed plan to face the complexities and difficulties of emergencyrooms, inpatient services, and residential programs will pave the way for excellence.• It is critical that the medical, psychopharmacological, and psychological aspects of thesedifferent kinds of intervention be addressed as soon possible by an interdisciplinary teamand be updated frequently as needed.• Many different types of programs provide an intermediate focus between emergency roomand outpatient care. It is important to choose the program most appropriate to the needs ofthe patient and to consider changes in disposition as the patient’s status changes.Specifics• In the emergency room, it is important to focus on safety and on the stabilization of the situation.• Clinical decisions should not be made simply out of concern for avoiding litigation; rather,they should be based on what is best in terms of safety and treatment of the patient.• Remember that discharge planning should begin with the very first encounter with the patient.• Be mindful of the challenge of having to provide a full therapeutic experience, even during ashort stay.REFERENCES AND RECOMMENDED READINGSAmerican Psychiatric Association. (2004). Practice guidelines for the treatment of psychiatric disorders.Compendium 2004. Arlington, VA: Author.Blaustein, M., & Viek, C. (1987). Problems and needs of operators of board-and-care homes: A survey.Hospital and Community Psychiatry, 38(7), 750–754.