Psychiatric services in a rural general hospital.

Rural areas face severe problems related to the inadequate distribution of psychiatrists. This paper describes a model of inpatient psychiatric care in a rural general hospital which has successfully overcome many of the constraints of the rural setting using a four member psychiatric consultation team. Using the medical community and its resources as the basis for care, a strong emphasis is also placed on continuing education for care providers. Important factors in the system include allowing all physicians to admit and care for psychiatric patients and the use of the emergency room physicians as interim admitting doctors when patients have no family physician. Other factors in the program are discussed. Problem areas have included continuity of care and treatment of certain types of patients. The results of the project have been an increase in the number of psychiatric patients admitted (140 to 268 per year) and a decrease in the number of patients sent to the state institution. Consultations requested on non-psychiatric patients, including children have increased from thirty-five to sixty-seven per year. Most patients now remain in the care of their own physicians throughout a mental illness episode. Cooperation between community practitioners and the center staff has improved. With increased skill, center and community physicians have shown greater self sufficiency in working with hospitalized patients and their families.