ABSTRACT
Nowhere has health care reform changed in America as it has with mental health. When I first came to a new hospital position, the average length of stay on the adolescent psychiatric unit was twenty-one days. The focus was on treatment and most of the patient's time was spent in group therapy, individual therapy, and family sessions. Five years later, such units function in a very different way. The focus is primarily on crisis stabilization. To be admitted at present, one must be a danger to one's self or to others. In general, this means some sort of self-harm such as cutting on one's body, attempted suicide, or making serious statements about doing so and having the means at hand to make good on the threats. It may also mean having intentions of harming others. The average length of stay is about five days. On occasion, persons with serious eating disorders are admitted, though usually for a longer period. Although the day is still filled with group and individual therapy, the goal is not to treat the condition so much as to stabilize the child emotionally (and medically if necessary), to determine medications needed, and to locate local community-based treatment options. Treatment has shifted outside the hospital.
