Who to Refer
A psychiatric diagnosis must be the reason for admission. (e.g., schizophrenia, unspecified psychotic disorder, bipolar disorder, MDD, PTSD, RAD, IED, ODD, etc.)
- Co-morbid drug/etoh use disorders are permitted, but cannot be the primary reason for admission. (For examples, severe alcohol withdrawal with DTs; actively tripping on LSD.)
- Co-morbid behavioral problems are permitted, but cannot be the primary reason for admission. (e.g., threatening to kill everyone whenever a child’s phone is confiscated by the parents; autistic child head-banging when routine is changed.)
- Co-morbid SI, HI, and grave disability are permitted (they can sometimes be reasons for involuntary paperwork (e.g., M1), but they cannot be the primary reason for admission. (e.g., patient with cancer who is not eating has a grave disability; patient sentenced to jail may threaten suicide if they are locked up – but neither is necessarily a psychiatric disorder.)
The hospitalization should be a better option than outpatient treatment. Reasons include:
- Safety. SI/HI/grave disability severe enough that outpatient treatment is not safe.
- Co-morbidity. Because of co-morbid medical concerns or withdrawal concerns or psychosocial problems, outpatient treatment is not safe.
- Efficacy. Attempts at outpatient treatment have not been successful, and the patient’s condition continues to deteriorate.
Patients should be safe for psychiatric hospitalization.
- Medical treatments requiring i.v. fluids or medications, regular cardiac monitoring, imaging, and/or dialysis are all likely contraindications.
- Requiring a specialized hospital bed or specialized nursing assistance can sometimes be contraindicated.