Reinventing Inpatient Psychiatry
Northwestern Memorial Hospital September 06, 2011
The plain white walls, fluorescent lights and sparse furnishings that make psychiatric units look like and feel like an institution will soon be a distant memory. Years of planning and preparation will culminate on September 24 when the first patients are welcomed into Northwestern Memorial Hospital’s new inpatient psychiatric unit. The innovative facility will feature a design layout and model of care that will be tailored to a psychiatric patient’s unique needs, resulting in a faster re-integration back into society.
“We are long overdue for a change in our model of inpatient psychiatric care,” said John Csernansky, MD, chair of psychiatry at Northwestern Memorial’s Stone Institute of Psychiatry.
Current models of inpatient psychiatric care were developed in the 1960s and 1970s when the severity of illness for patients was much lower, and lengths of stay were much longer. Today, the challenges of providing care include treating more severely ill patients in shorter periods of time, preparing them effectively for their transition to outpatient care, and ensuring their seamless transition back into their communities.
“At Northwestern Medicine, we’re reinventing the inpatient model of care by using everything we have learned from clinical neuroscience research to provide more effective care,” said Csernansky who is also chair of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine.
The new inpatient unit was constructed to ensure patients have exceptional care, while maintaining dignity, privacy and safety in a healing environment. The center will consist of 25 private rooms and two double rooms featuring clean lines and no clutter to encourage a soothing atmosphere. The new space is filled with an abundance of natural light and calming artwork on the walls. The ability to dim overhead lighting during sunrise and sunset will aid in treatment of sleep disturbances.
Care in the new unit will be delivered in what’s called a “neighborhood” concept where there’s a focus on restoring normal psychology and patterns of physical behavior by replicating a “model of life.” Patients’ rooms are considered their “home,” while the dayroom is the “neighborhood.” The treatment mall, where patients have group sessions, is thought of as “working downtown.” This concept will aid in helping the patient transition from inpatient to outpatient care.
The space includes three dayrooms, where patients can watch educational dvds, play games or socialize. In two day rooms, there are televisions for patients to watch the news or sports during unstructured time. Computers are available for patients to connect with their families and outside community. Patients can also choose to use a meditation room that features special lighting that can be individualized in brightness and color per patient preference.
An exercise room encourages patients to engage in healthy behaviors. Treadmills, elliptical and bicycles as well as yoga classes will be offered. “The integration of physical health with mental therapy is extremely important,” said Cathy Frank, MD, inpatient medical director at Stone. “Patients with mental disorders have a higher chance of developing physical problems. For example, people with schizophrenia have a 25 year shorter life span than the average adult because of the physical toll this mental disorder takes on the body and the risk of developing additional disorders.”
Another unique feature of the unit is that it was constructed under the guiding principle called “on-stage/off-stage.” The patient care space is considered the “on-stage” area. Separate exits/entrances were designed so that only those professionals caring for and directly supporting the patients will have access to those areas. “All other areas are considered “off-stage” and have limited access for assigned support personnel to maintain the patients’ privacy,” said Maureen Slade, RN, MS, director of Stone Institute of Psychiatry. “If someone is not in direct care of the patient, they are “invisible” to the patient.”
The inpatient unit at Stone combines a multitude of interventions to accelerate treatment response and prepare the patient for reintegration into their community. “From the first contact with the patient, our goal is early intervention and early engagement with the patient’s family,” said Frank. “A combination of four specific elements is needed to support the patient and provide a trajectory towards health: a healing environment, evidenced-based psychotherapy, expert pharmacology and neuromodulation.”
Northwestern Memorial Hospital clinicians are embedding a form of cognitive therapy, called behavioral activation, in which the patient will learn techniques to actively manage their illness by participating in activities that will promote goal accomplishment, increase motivation, and manage stress and compliance to a treatment plan. Stone Institute of Psychiatry is the first inpatient unit in the country providing this type of therapy as the therapeutic environment or milieu for inpatient psychiatric care.
“Our goal is to accelerate recovery, and promote independence and functionality. We don’t want our patients to just get better, but to have full remission,” said Frank.
To make an appointment for psychiatric care at Northwestern Memorial Hospital please call 312.926.0779. Clinicians who wish to learn more can also attend “Reinventing Inpatient Psychiatry,” a symposium on September 9th and 10th to provide a forum that highlights and integrates emergent knowledge in the care of psychiatric inpatients.