Psychiatric hospital wards
Psychiatric hospital treatment should be applied only in case of severe mental disorders with behaviours dangerous for life and/or health of the patient or his/her family. Inpatient therapy is also dedicated to patients, feeling helpless and lost for their mental disorders, unable to fulfil basic living needs, demanding diagnostics and therapy in conditions of 24-h medical care, deprived of any care at home.
An indication to hospital therapy is also both concomitance of mental and somatic disorders, which require specialist diagnosis and therapy in conditions with 24-h access to medical services and with potential to carry out diagnostic and therapeutic procedures of increased risk, requiring medical protection in hospital environment (e.g. diagnostic puncture, electric shock procedures). At psychiatric hospitals, 24-h specialist wards are arranged, such as:
- for early and late rehabilitation in psychotic disorders,
- for treatment of depression, affective conditions,
- for treatment of neurosis, personality disorders,
- for treatment of alcohol and substance addiction,
- for detoxification,
- forensic psychiatry.
The unfavourable impacts of hospital environment are minimised by restructuring of large hospital complexes, building in them the above-mentioned specialised wards and by transfers of some beds to psychiatric wards in general - multidisciplinary hospitals.
The localisation of psychiatric inpatient therapy at wards of general hospitals is supported - beside better access to specialised diagnostic base and medical consultations - by equalising of the status of psychiatric patients and the status of patients with somatic diseases, what counteracts stigmatisation of psychiatric patients. Such stigmatisation was observed in traditional psychiatric hospitals. A psychiatric ward should not have more than 20-30 beds, arranged in 1-4-patient rooms A psychiatric ward employs psychiatric doctors, clinical psychologists, a psychotherapist, a social worker, occupational therapists and a nurse.
A psychiatric ward should not have more than 20-30 beds, arranged in 1-4-patient rooms A psychiatric ward employs psychiatric doctors, clinical psychologists, a psychotherapist, a social worker, occupational therapists and a nurse.
The work of such a ward is organised on the principle of therapeutic community. The therapeutic programme at the ward includes occupational activity therapy and various forms of activation, recreation and social contacts.
The patient, immediately after admission, is instructed in the ward's topography and statute, the patient's rights and the possibility of access to the Patient Ombudsman. During his/her stay at the ward, the patient has got appropriate space to keep personal belongings with a possibility to secure valuable objects and financial means in deposit.
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In the course of hospital therapy, the patient has the right to unconstrained contacts with his/her family and close friends (correspondence, telephone calls, visits), as well as to contact the Patient Ombudsman of the psychiatric hospital.
Patients with improved health condition are also able to freely leave the ward to the hospital (the "open door" system or a document, allowing to leave the ward), as well as - in agreement with the doctor and the family - the patients are also allowed to go home on pass (home training) for some time.
A multilevel diagnosis is carried out at the ward of the patient's medical, psychosocial and social problems. Then a therapeutic plan is developed by the therapeutic team which takes into account:
- the treatment of mental and somatic state,
- psychoeducation and support to the patient and his/her family,
- psychological and psychosocial impacts,
- environmental and social interventions,
- improved functioning.
How is the admission to a psychiatric ward arranged and when a discharge from hospital can be issued?
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Admission to a 24-h psychiatric inpatient ward is possible by referral, issued by a psychiatrist (at a mental health outpatient clinic, a team of environmental therapy, a day-care ward or other unit) and by decision of a psychiatric doctor at the admission department of the hospital and a written consent of the patient.
Treatment at a hospital psychiatric ward is free of charge (acc. to the act of mental health protection). Regarding non-insured patients, a social worker of the ward helps to insure via the Employment Office or via the social welfare centre. Employed patients are on sick-leave during treatment at hospital. On admission to a hospital psychiatric ward, the patient provides a written consent to treatment and a separate consent to inform a definite close person about his/her health condition and disclose medical documentation.
In case of emergency, the admission of a psychiatric ward at hospital is also possible without valid referral from psychiatric doctor - the decision is then taken by the doctor on duty at the hospital admission department. When the patient does not agree to be admitted to the hospital psychiatric ward, the admission and treatment may take place without the patient's consent and by measures of compulsion but only when the ill patient threatens his/her own life or health or is a threat to life or health of other persons.
Similarly, when the patient endangers his/her own life of the health or life of other persons and the patient's behaviour indicates a possibility of mental disease, which, however, has not been confirmed, he/she may be admitted to hospital without his/her consent for an observation period of max 10 days. When the patient's condition is not an immediate danger to his or others' life and/or health, the mentally ill patient may be admitted to hospital and treated by decision of the family court, issued by request of the patient's family, legal or factual guardian or a social welfare organ.
The patient, admitted to a psychiatric hospital without his/her consent, should be informed about admission causes and about the rights to which he/she is entitled. Such a patient may demand discharge and should be discharged at expiration of the assumptions to observe or treat the patient without his/her consent. In Poland now, the patient's right to selection of treatment site is respected.
However, in consideration of the still high demand for hospital treatment and the lack of free beds, regions of obligatory admission have been defined for particular hospital wards, obligated to receive a patient in acute condition or to find a place in another hospital (ward) with ensured transportation. Patients, who do not require emergency admission, can be included into the waiting list.
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Discharge from hospital is preceded by an adaptation period of life outside the ward - with periodical passes to home (home training periods).
During this period, it is evaluated what form of therapy, rehabilitation and support will be required for the patient after discharge and to which environmental unit he/she should be referred.
Even with optimally functional psychiatric ward, it should be aimed that the patient was discharged as soon as possible and referred to units of environmental psychiatric therapy (a hostel, a day-care ward, team of environmental therapy, outpatient clinic).
Patients with big functional problems should be, after discharge, covered with a parallel social support at the place of residence and in local environment by referral, among others, to:
- day-support centre - environmental self-help home,
- specialist, psychiatric care services at home,
- workshop of occupational therapy or other activation form.
Residential care facilities
All individuals who are incapable of satisfying their basic needs – because of a mental condition or disability – and are thus unable to exist independently, but cannot be properly cared for in their own homes, or are hospitalized in a mental hospital, but qualify for outpatient mental care, have the right to 24-hour care at a residential care facilities. The persons, entitled to health care services at a residential care facility are persons, covered with statutory - mandatory or voluntary health insurance (regulated by the act of health care services financed from public funds).
What documents are required to be admitted to a residential care facility?
An application for admission to residential care facility is to be prepared and submitted to its manager.
Such an application should include:
- evaluation of the patient's ability for personal self-service;
- a statement of consent of the applying person (or their legal representative or legal guardian); in case of a patient unable to provide a conscious consent, it is necessary to obtain a decision of the family court - appropriate for the area where medical service was provided;
- a written declaration of consent (or its lack) to disclose information about the patient's health condition;
- a copy of the patient's ID card (as well as og his/her legal representative or legal guardian).
The application must be accompanied by the following documents:
- a medical certificate, stating that the applicant, taking into account his/her health condition, requires 24-h care, nursing or rehabilitation but does not require hospitalisation;
- nursing history, obtained by an environmental (family) nurse or a social nurse of from a health care unit (hospital), at which the person, who applies for admission at the residential care facility, is now a patient;
- documents, confirming the amount of the applicant's income or of the income of the person who will pay for the applicant's stay at the residential care facility, including, in particular:
declaration of the amount and type of income;
decision of the retirement-pension organ, which determines the amount of retirement or pension benefits; to that decision, the applicant's consent is enclosed to deduction of the fee for the stay at the residential care facility from his/her retirement/pension benefits by the retirement-pension organ.
Admissions to residential care facilities are arranged acc. to the sequence of submitted applications. If there are no free places - acc. to the waiting list. Patients are admitted to residential care facilities for the period of 6-12 months.
After that period, when the patient's abilities are recovered, he/she returns to his/her original environment. If, however, the patient's condition will not enable his/her return to normal life, then his/her stay may be prolonged or he/she may be transferred to a nursing home for an unlimited period of time.
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The stay at a residential care facility requires payment of a monthly fee, corresponding to 25% of the lowest retirement benefit, while this fee must not be higher from 70% of the monthly income of the person, staying at the residential care facility.