The private general hospital's psychiatric emergency service in a decade of transition.

The psychiatric emergency ward of the private general hospital is faced with increasing demands for services and a changing role as a result of the progression of deinstitutionalization and shifts in the relationships between public and private facilities. Ten years ago the psychiatric emergency ward operated primarily as an evaluation and referral unit, triaging patients to primary sources of care; today the public facilities that serve as the primary caregivers frequently turn referrals away. Thus the referral model of service delivery is no longer viable for a psychiatric emergency ward, but it is yet to be replaced by other programs within the ward that will enable the chaos of the current system to be bypassed and prevent further deterioration of patient care. The authors discuss the dilemmas facing the emergency ward staff in the management and treatment of involuntary, psychotic, and chronic crisis patients.