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Ask the Mental Health Expert Archives 2001-2004

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Staff Communication

Q. How do you ensure effective communication between staff in acute and community mental health services? It often appears that the left hand does not know what the right hand is doing.

A. Since the deinstitutionalization movement of the 1950s and '60s, the challenge of integrating inpatient and outpatient/community mental health services has been enormous. I think you are right in noting that communication between acute care and community psychiatric services is often less than terrific. How do we ensure that such communication takes place? I suspect that the only way to do that is to write it into law. Indeed, the state of Washington did essentially that (see Semke and Hanig, Psychiatric Services, March 1995).

As these authors from the University of Washington state, "The regional authorities and the state's two state hospitals have agreed on procedures for hospital admissions and discharges that require hospital staff to notify community mental health staff when clients are hospitalized and that require community staff to participate in discharge planning at the state hospitals." Another program in Washington state involves the use of state hospital staff to train staff in community residential facilities, using the hospital as the campus (see Peterson and Borland, psychiatric Services, May 1995).

In my own experience as director of an acute inpatient unit, it is very important to have outpatient/community service staff involved in discharge planning. This means inviting selected outpatient staff to team meetings on the unit, and, in some cases, having inpatient staff visit the residential or outpatient mental health facility with the patient, well in advance of discharge. Communication between the inpatient and outpatient psychiatrist is also important--sometimes one or the other will make radical changes in a patient's medication, not realizing that these changes have failed in the past. All that said, the odds that we can ever ensure good communication are pretty low!

June 2001

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