The Casebook of a Residential Care Psychiatrist: Psychopharmacosocioeconomics and the Treatment of Schizophrenia in Residential Care Facilities

by Martin Fleishman

Overview

Discover an alternative realm of psychiatry—without offices or couches!

The Casebook of a Residential Care Psychiatrist: Psychopharmacosocioeconomics and the Treatment of Schizophrenia in Residential Care Facilities addresses the problems involved in the onsite treatment of mentally ill patients in residential care facilities. This book is the first to identify the need for psychiatrists to be available to individuals in such facilities as adult homes, community care homes, transitional living facilities, and rest homes. This vital resource also contains specific recommendations as to how these visits should be conducted with regard to frequency, duration, space, and the types of Medicare procedure codes to utilize.

In The Casebook of a Residential Care Psychiatrist, Dr. Fleishman uses his 40 years of experience as a psychiatrist to show you the ins and outs of practicing psychiatry in residential facilities. The book also discusses the profound changes psychiatric drugs have produced in the social, economic, and legal arenas. Using anecdotes, personal stories, and actual documents from Dr. Fleishman’s files, this book provides you with a wealth of knowledge not found anywhere else.

With this book, you’ll learn more about:

• time-saving interview/assessment techniques
• the importance of psychopharmacology in residential care and how it has changed the practice of psychiatry
• Dr. Fleishman’s method for appropriately creating and using progress notes and other records during treatment
• ways to work with other members of the residential facility professional community—including psychologists, social workers, pharmacists, and administrators—to make everyone’s job easier
• the best ways to control paperwork obligations
• the impact that federal, state, and local government agencies have had on mental health spending, services, and practitioners

In The Casebook of a Residential Care Psychiatrist, you will find wisdom, knowledge, and advice along with case studies, tables and examples. While focused on psychiatry and schizophrenia, this book will be of interest to mental health workers, long-term caregivers, and residential facility administrators as well as psychiatrists and psychologists.

Product Details

ISBN-13:	9780789023735
Publisher:	Taylor & Francis
Publication date:	02/03/2005
Pages:	476
Product dimensions:	5.44(w) x 8.50(h) x (d)

Table of Contents

• Foreword (Steven S. Sharfstein)
• Preface
• Acknowledgments
• Introduction
• The Goals of This Book
• PART I: THE PLACES
• Chapter 1. What Is a Residential Care Facility?
• Infrequently Asked Questions
• Chapter 2. The Problem of the Problem
• The Problem of Data Collection
• Chapter 3. The History
• Residential Care Facilities in San Francisco
• Personal History
• The Pioneers
• Chapter 4. The Facility
• The Evolution of Residential Care Facilities
• Case Histories
• Specialized Referral Patterns
• PART II: THE PEOPLE
• Chapter 5. Who Should Do It?
• Psychotherapeutic Considerations
• The Advantages of a Sense of Humor
• Behavioral Therapy Applications
• Group Psychotherapy Considerations
• Chapter 6. The Job Description
• Chapter 7. The Cast
• The Patient
• The General Medical Physician
• The Social Worker
• The Psychologist
• The Administrator
• The Pharmacist
• The Case Manager
• Relatives
• The Modern Residential Care Psychiatric Team
• PART III: THE PROBLEMS
• Chapter 8. How It Should Be Done: Space, Time, and Techniques
• Space Constraints
• Time Constraints
• The Techniques
• Chapter 9. The Problems of Frequency and Duration
• Visitation Frequency in Relation to the Unpredictability of Adverse Events
• The Standard of Care in the Community
• The Problem of Duration
• The Effects of Off-Site Work on On-Site Visits
• A Typical Day in the Life of a Residential Care Facility Psychiatrist
• Chapter 10. Why Do It?
• The Value of On-Site Visits by Psychiatrists and the "Continuity of Care" Issue
• Clinical Examples of the Advantage of On-Site Encounters
• The Effect of On-Site Visits on the Administrator
• Chapter 11. The Residential Care Facility First-Aid Paperwork Reduction Kit
• Chapter 12. The Legal Problems
• Recent Changes in Residential Care Psychiatry
• The Impact of HIPAA
• The Problem of Medical Necessity
• Redefining Medical Necessity for Psychiatry
• Computers and the Medicare Audit
• Computers and the Medicaid Audit
• Audits and Health Care Fraud
• Chapter 13. The Medicare Audit Process
• Chapter 14. Progress Note Problems
• Examples of Progress Notes
• Medicare Policies Regarding Progress Notes
• Chapter 15. Special Problems
• The Poorly Organized Facility with Substandard Professional Services
• The Well-Organized Facility with Regular Visits by the MRCPT
• The Well-Organized Facility with No Regular Visits by the MRCPT
• The Nonemergency Emergency
• The Problems That Occur When MRCPT Members Do Not Visit Regularly
• Chapter 16. Suicide
• Chapter 17. IM Medications—How to Do It and Why
• The Technique of IM Administration
• Clinical Examples of the Use of Long-Acting IM Depot Injections
• PART IV: REMEMBRANCES OF THINGS PAST
• Chapter 18. School Days
• Chapter 19. How to Fail in Psychology Without Really Trying
• Chapter 20. Life in the Prechlorpromazine Era of Nongeological Time
• PART V: ISSUES IN PSYCHOPHARMACOSOCIOECONOMICS
• Chapter 21. How Antipsychotic Drugs Have Changed the World
• Chapter 22. The Cost of the Treatment of Schizophrenia for Society
• Chapter 23. The Costs of the Treatment of Schizophrenia for the Patient
• Chapter 24. How On-Site Services Can Reduce the Cost of Treatment
• Chapter 25. Residential Care Facilities and the Cost Savings Associated with Rehospitalization
• PART VI: SUMMING UP
  

What People are Saying About This

Lawrence B. Lurie

MUCH-NEEDED. . . . Sheds light on a formerly ignored subject. . . . A book of clinical wisdom and gems. . . . A DELIGHT TO READ AS WELL AS A PROFOUND LEARNING EXPERIENCE. . . . I learned from the clinical 'how-to' about when to give an IM injection and obtain the appropriate lab tests. I was educated on the bureaucratic 'how-to' of dealing with a Medicare audit and on the intricacies of coding. Dealing with the severely and chronically mentally ill, Dr. Fleishman gives us multiple vignettes that illustrate psychopharmacy. In his humorous way, as he discusses his own psychopathology, he helps improve our understanding of his/our patients.
—MD, DFAPA, Chair, APA Committee on Managed Care; Clinical Professor of Psychiatry, University of California, San Francisco

Pedro Ruiz

Dr. Fleishman presents A UNIQUE AND RELEVANT PERSPECTIVE on the dehospitalization process that affected many severely ill psychiatric patients during the last half-century. Additionally, he offers an excellent description of the role of residential care in today's psychiatric practice in the United States. THIS BOOK MUST BE READ BY ALL PSYCHIATRIC PRACTITIONERS. It offers a CLEAR AND COMPREHENSIVE view of the current mental health system in the United States. I particularly enjoyed the series of chapters on the very important topic of psychopharmacosocioeconomics.
—MD, Vice President, American Psychiatric Association; Past President, American College of Psychiatrists; Professor and Vice Chair, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston

Editorial Reviews

3 Stars from Doody

Reviewer: Raj Tummala, MD (Wyeth Pharmaceuticals)
Description: This is a thorough review of patient treatment in residential care facilities with a focus on patients with schizophrenia. This book is an absolute must for any clinician taking care of patients in private residential facilities.
Purpose: TThe purpose is to provide a comprehensive, easy to read, quick reference of the residential care system.
Audience: It is targeted at anyone dealing with patients in residential care settings such as psychiatrists, residents, social workers, case managers, etc.
Features: Psychopharmacological advances and economic legislations have led to the deinstitutionalization of psychiatry. As a result, chronically ill psychiatric patients now reside in residential facilities. Dr. Fleishman details his experiences in this well written review on the residential treatment system. He starts off with the history of residential care systems and outlines the facilities, the team responsible for the care of the patient with various intervention modalities. He uses case vignettes, and spreads his humor throughout. The section on space, time and techniques deserves special mention: in it, Dr. Fleishman outlines "The Ten Commandments of Residential Care Psychiatry." In view of the disparities that arise in the treatment of mentally ill patients, Dr. Fleishman outlines the various legal and economic problems and calls for a new definition of medical necessity. He does a wonderful job of explaining the Medicare audit process and the complexities associated with the Medicare system. The book has a focus on schizophrenic patients, as they comprise the majority of the patients in these settings. Special emphasis is placed on various pharmacoeconomic measures that reduce costs as a result of on-site services and new pharmacological advances. Dr. Fleishman states six goals for writing this book, including new legislation, Medicare reform, and guidelines for residential care. He has done a great job of making a case for all six of his goals.
Assessment: The book is written in a very practical, user-friendly format differentiating itself from other books in this category. It is an absolute must for anyone dealing with patients in residential care settings.

Doody's Review Service