Maria Parham Behavioral Health Admissions Criteria

Adult Intake and Admission

Admission Criteria:

Admission to an inpatient psychiatric program is indicated for adults who have DSM 5 diagnoses and, in addition, meet the severity of illness and intensity of service criteria (at least one from each) listed here. The decision for admission rests with the psychiatrist.

Exceptions to the guidelines are approved by the admitting psychiatrist in advance and are based on an assessment of individual patient needs.

Procedure

A. Admission Criteria

1. Suicide attempts and a threat to self require 24-hour professional observation.
2. Suicidal ideation or gesture within 72 hours prior to admission.
3. Self-mutilation behavior (actual or threatened) within 72 hours of admission.
4. Homicidal ideation, a threat to others, requires 24 hours of professional observation.
5. Assaultive behavior threatening others within 72 hours prior to admission.
6. Command hallucinations direct harm to self or others where there is a risk of the patient taking action.
7. Chronic and continuing self-destructive behavior that poses a significant and/or immediate threat to life, limb, or bodily function.
8. Psychiatric symptoms (e.g., hallucinations, delusions, panic reaction, anxiety, agitation, depression) severe enough to cause disordered, bizarre behavior (e.g., catatonia, mania, incoherence, sexually inappropriate behavior) or psychomotor retardation resulting in significant interference with activities of daily living.
9. Cognitive impairment (disorientation or memory impairment) due to an acute psychiatric disorder that endangers the welfare of patients or others.
10. For patients with a dementing disorder for evaluation or treatment of psychiatric comorbidity (e.g., risk of suicide, violence, severe depression) warranting inpatient admission.
11. A mental disorder causing major disability in social, interpersonal, occupational, and/or educational functioning that is leading to dangerous or life-threatening behavior.
12. A mental disorder that causes an inability to maintain adequate nutrition or self-care and family/community support cannot provide reliable, essential care so that the patient cannot function at a less intensive level of care during evaluation and treatment.
13. Toxic reactions to psychotropic medications and require medication monitoring and adjustment. 
14. Failure of outpatient psychiatric treatment so that the individual requires 24 hours of professional observation and care. Reasons for the failure of  outpatient treatment could include:
    • Increasing severity of psychiatric symptoms;
    • Non-adherence with medication regimen due to the severity of psychiatric symptoms;
    • Inadequate clinical response to psychotropic medications;
    • Due to the severity of psychiatric symptoms, the patient is unable to participate in an outpatient psychiatric treatment program.

B. Exclusionary Criteria

The physician evaluates each case on an individual basis.

1. Patients with a substantiated diagnosis of dementia with no acute behavioral change or no known psychiatric disorder and no expectation for a positive response to treatment.
2. Patients with life-threatening acute medical or surgical illnesses will not be accepted.
3. Patients with terminal diseases without a treatable psychiatric disorder will be referred to an appropriate hospice facility.
4. Patients with complex medical/surgical procedures, preventing their participation in the active treatment program.
5. Patients with a primary substance use disorder.
6. Patients with a blood alcohol level of 0.1 or higher will be held until the level is below 0.1.   Exceptions may be made at the physician’s discretion.
7. The individual poses a known privacy concern (such as another family member is on the unit or some similar situation).
8. The patient requires a higher level of care than the facility is able to safely and adequately provide.

Geriatric Intake and Admission

Admission Criteria:

Admission to an inpatient psychiatric program is indicated for patients ages 55 and above who have DSM 5 diagnoses and, in addition, meet the severity of illness and intensity of service criteria (at least one from each) listed here. The decision for admission rests with the psychiatrist.

Exceptions to the age guidelines are approved by the admitting psychiatrist in advance and are based on an assessment of individual patient needs.

Procedure

A. Admission Criteria

1. Suicide attempts and a threat to self require 24-hour professional observation.
2. Suicidal ideation or gesture within 72 hours prior to admission.
3. Self-mutilation behavior (actual or threatened) within 72 hours of admission.
4. Homicidal ideation, a threat to others, requires 24 hours of professional observation.
5. Assaultive behavior threatening others within 72 hours prior to admission.
6. Command hallucinations direct harm to self or others where there is a risk of the patient taking action.
7. Chronic and continuing self-destructive behavior that poses a significant and/or immediate threat to life, limb, or bodily function.
8. Psychiatric symptoms (e.g., hallucinations, delusions, panic reaction, anxiety, agitation, depression) severe enough to cause disordered, bizarre behavior (e.g., catatonia, mania, incoherence, sexually inappropriate behavior) or psychomotor retardation resulting in significant interference with activities of daily living.
9. Cognitive impairment (disorientation or memory impairment) due to an acute psychiatric disorder that endangers the welfare of patients or others.
10. For patients with a dementing disorder for evaluation or treatment of psychiatric comorbidity (e.g., risk of suicide, violence, severe depression) warranting inpatient admission.
11. A mental disorder causing major disability in social, interpersonal, occupational, and/or educational functioning that is leading to dangerous or life-threatening behavior.
12. A mental disorder that causes an inability to maintain adequate nutrition or self-care and family/community support cannot provide reliable, essential care, so that the patient cannot function at a less intensive level of care during evaluation and treatment.
13. Toxic reactions to psychotropic medications and require medication monitoring and adjustment.
14. Failure of outpatient psychiatric treatment so that the individual requires 24 hours of professional observation and care. Reasons for the failure of outpatient treatment could include:
    • Increasing severity of psychiatric symptoms;
    • Non-adherence with medication regimen due to the severity of psychiatric symptoms;
    • Inadequate clinical response to psychotropic medications;
    • Due to the severity of psychiatric symptoms, the patient is unable to participate in an outpatient psychiatric treatment program.

B. Exclusionary Criteria

The physician evaluates each case on an individual basis.

1. Patients with a substantiated diagnosis of dementia with no acute behavioral change or no known psychiatric disorder and no expectation for a positive response to treatment.
2. Patients with life-threatening acute medical or surgical illnesses will not be accepted.
3. Patients with terminal diseases without a treatable psychiatric disorder will be referred to an appropriate hospice facility.
4. Patients with complex medical/surgical procedures, preventing their participation in the active treatment program.
5. Patients with a primary substance use disorder.
6. Patients with a blood alcohol level of 0.1 or higher will be held until the level is below 0.1.   Exceptions may be made at the physician’s discretion.
7. The individual poses a known privacy concern (such as another family member is on the unit or some similar situation).
8. The patient requires a higher level of care than the facility is able to safely and adequately provide.