Psychiatry in the general hospital: visualizing the changes.

The general hospital of the future faces the difficult task of maintaining quality of care in light of increasing demands for service and increasing efforts to control costs. Psychiatric units in general hospitals will share this challenge, reflected in such issues as the need to document the cost-effectiveness of services, delineate what circumstances justify the use of inpatient services, and resolve conflicts between (and obtain appropriate reimbursement for) all mental health disciplines. Psychiatry will find it easier to adapt to other changes in general hospital practice, such as the need for greater continuity of care and for varying levels of intensity of care, because of its previous experience in those areas. Through all the changes, psychiatry must continue to speak for the individuality of each patient, not only the psychiatric service but throughout the general hospital.