A psychiatrist works in four ways in primary care:
Advice and train general practitioners and their staff:
In this category, the psychiatrist does not see the patients but give advice based on the assessment of the general practitioner.
Assessment of the patient:
The psychiatrist assesses the patient when the general practitioner is uncertain about the diagnosis and refers the individual to the psychiatrist. The psychiatrist follows various procedures and techniques and may also prescribe certain tests to complete the evaluation process.
Assessment and treatment:
The psychiatrist sees the patients either at home or at the primary care clinics and recommends behavioral therapy, counseling and assessment to the patients. Here a contact is established between the psychiatric team and the patient to follow up on dates and offer doorstep assistance.
Shared care:
Here the general physician and head f the psychiatric team assign key roles and responsibilities to various members of the team on how to deal with a patient and take care of him/her.
In cases where the patients might be considered dangerous to themselves or others or where their symptoms are so severe that they are unable to care for themselves in the community, psychiatric hospitalization may be required. Most of the traditional forms of therapy may be used in a hospital setting to help restore the patient to functioning. In addition, in many mental hospitals these techniques are being supplemented by efforts to make the hospital environment itself a therapeutic community. All the ongoing activities of the hospital are brought into the total treatment program and the environment or milieu is a crucial aspect of the therapy. This approach is often referred to as milieu therapy. Three general therapeutic principles guide this approach to treatment work in primary care by the psychiatric team:
Staff expectations are clearly communicated to patients. Both positive and negative feedback are used to encourage appropriate verbalizations and actions by patients.
Patients are encouraged to become involved in all decisions made and all actions taken concerning them. A self-care, do-it yourself attitude prevails.
All patients belong to social groups of the ward. The experience of group cohesiveness gives the patients support and encouragement and the related process of group pressure helps exert control over their behavior.
In a therapeutic community, very few restraints are placed on the patients’ freedom and the aim is to encourage them to take responsibility for their behavior and to participate actively in their treatment. Open wards permit patients to use the grounds and premises. Self-government programs give patients the responsibility to manage their own affairs and those of the ward. All hospital personnel are expected to treat the patients as human beings who merit consideration and courtesy. The interaction among patients is planned in such a way as to be of therapeutic benefit.
Social learning Programs: These programs make use of learning principles and techniques such as token economies to shape more socially acceptable behavior.
A persistent concern with hospitalization is that the mental hospital may become a permanent refuge from the world, either because it offers total escape from the demands of everyday living or because it encourages patients to settle into a chronic sick role with a permanent excuse for letting other people take care of them. Over the past tree decades there has been considerable effort at reducing the population of inpatients by closing hospitals and treating patients with mental disorders on an outpatient basis. This effort, often referred to as deinstitutionalization, was initiated to prevent the often negative experiences many psychiatric patients have had when confined to a mental hospital for long periods of time.
