What is Integrated Medicine Psychiatry Treatment?
Rene Descartes introduced the concept of Cartesian Dualism. He proposed that the mind of man is distinct from the body with minimal interaction between the two. With the advent of new technology research has shown this concept to be erroneous. However, our models for provision of medical and psychiatric services continue to be based on this theory. In most instances different specialists provide psychiatric and medical services. The psychiatric and medical services are provided in different locations. Sources of payment are frequently different. Patients with concurrent medical and psychiatric issues often have poorer treatment outcomes and higher costs associated with treatment. Integrated programs provide psychiatric and medical care in one location by professionals trained in both specialties.
What is Medicine Psychiatry Social Work?
Social Workers who are staffing Integrated Treatment Units are finding that they need to employ specialized and in some cases unique interventions for their patients. The social work interventions must take into account the patient’s comorbid conditions, physical and social environment, obstacles to integration with the environment, secondary social and behavioral concerns.
The social worker is challenged to help the patient see his brain based psychiatric and medical issues as part of an integrated whole physiology. At the same time the social worker and patient attempt to develop long range plans that integrate social/environmental resources, which have traditionally been provided through dualistic systems, into the patient’s aftercare plan.
First, the patient is seen as part of a larger system. Systems theory seems to be particularly applicable to this patient population and helps to identify issues in the larger context of the whole system and the dynamic equilibrium that is affected by a change in any part of the system.
Second, strengths based social work practice is being used with success. Rather than seeing the patient as a person with defects, the patient is seen as person who has strengths and resources that can be used by the patient to cope successfully with both medical and psychiatric challenges. The patient’s environmental niche is crucial to the patient’s success.
Third, there is a strong focus on providing education and adjustment to illness counseling to the patient and significant others to allow them to reframe the patient’s challenges in terms of evidenced based psychiatric treatment and disease management principles.
Fourth, efforts are made to provide services that will prevent the need for further hospitalizations and support the patient’s successful integration into the community.
What training is appropriate for a social worker on an Integrated Treatment Unit?
The person needs to have an in-depth knowledge of evidenced-based psychiatric and medical diagnoses and treatment options.
S/he also needs to know the way in which psychiatric and medical services are provided. Funding for these services is usually complex and provided through multiple sources. Because the ongoing care that patients need requires a combination of services that are traditionally provided through separate agencies, the social worker needs to develop a network of community providers who are willing to work out individual arrangements for patients.
Since many of the Integrated Treatment Units are locked, the social worker needs to be aware of the laws regarding advanced directives, guardianship and commitment. These laws vary from state to state and present different challenges based on the state. A significant percentage of patients who are treated on Integrated Units are unable to make decisions regarding their own care during at least part of their admission. The social worker needs to be aware of the legal options for substitute decision making.
What about caseloads and case mix?
Our most current research indicates that the average caseload is 15.7 patients to 1 social worker. This includes all units with various levels of acuity. Each unit is somewhat different in acuity and therefore, the caseload needs to be adjusted to allow for the complexity of the patient population. Discussion is ongoing about what is the optimum patient to social worker ratio, and some units are staffing at a 6 patient to 1 social worker ratio in order to shorten length of stay.
Helpful links:
For more information about social work in
medicine psychiatry, contact:
schael-engel@uiowa.edu
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