Cost-effective tertiary care.

We have highlighted several key points: There is a discrete subgroup of psychiatric patients who benefit from tertiary care. This treatment demands extraordinary intensity of staffing within the context of a facility whose leadership (and ownership) is committed to that level of care. Treatment should optimally occur within small residential units with clinically homogeneous populations of defined age range. mechanisms of quality control, including extensive programs of orientation, inservice, and utilization review, are paramount in achievement of success. Financial feasibility is dependent on maintenance of a high rate of occupancy, which in turn is reflective of the facility's effectiveness in fulfillment of its clinical mandate. Financial feasibility is dependent on a low relapse rate. Integration of biologic, psychologic antisocial aspects of treatment is the key to effectiveness. An intensively staffed and well-integrated unit is essential.