Mental Health Counselors' Decision-Making Priorities Related to Inpatient Admissions for Anxiety Disordered Clients: A Pilot Study

By Schwartz, Robert C.; Zarski, John J. et al. | Journal of Mental Health Counseling, October 2004 | Go to article overview

Mental Health Counselors' Decision-Making Priorities Related to Inpatient Admissions for Anxiety Disordered Clients: A Pilot Study


Schwartz, Robert C., Zarski, John J., Hilscher, Randall L., Journal of Mental Health Counseling


Factors related to making decisions about whether or not a client should be admitted as an inpatient are poorly understood. Research focused on mental health counselors' decision-making priorities related to admission decisions for anxiety disordered clients is scant. This pilot study assessed which clinical factors most led mental health counselors to recommend an immediate inpatient admission among anxiety disordered clients presenting at a community mental health center. Results revealed that suicidality and inability to care for oneself strongly predicted the recommendations for an inpatient admission. Clinical and research implications are discussed.

**********

Anxiety disorders is one of 16 major diagnostic classes used by the American Psychiatric Association (APA, 2000) to classify mental disorders. The prevalence of specific anxiety disorders varies: The APA has reported lifetime prevalence rates in adult American samples of 1% to 2% for panic disorder, 7.2% to 11.3% for phobias, 2.5% for obsessive-compulsive disorder, 8% for posttraumatic stress disorder, and 5% for generalized anxiety disorder. According to the National Institutes of Mental Health (NIMH, 2001), 19 million Americans are affected by anxiety disorders annually. Moreover, NIMH has stated that anxiety disorders cost the United States nearly $46.6 billion a year in direct and indirect costs, equaling nearly one third of all American mental health expenditures.

A variety of treatment options exist, including psychiatric hospitalization in severe cases. Mental health counselors (MHCs) must choose among available treatment options on the basis of the nature and severity of presenting symptoms and related risk factors. The decision about whether hospitalization is required is difficult to make and has significant consequences for the client. As Way and Banks (2001) noted, inappropriate decisions either to admit or release clients can have profound negative impacts, including (a) an increased risk of self-harm or violence to others if a client needing inpatient treatment is misdirected and (b) stigmatization or loss of important social resources (e.g., housing, employment, child custody, finances) if an inappropriate admission occurs.

In the literature on inpatient hospitalizations, most studies focus on physician decisions for patients presenting at psychiatric clinics or hospitals. Only one study found to date (Hendryx & Rohland, 1997) addressed factors influencing the hospitalization decisions of MHCs. These researchers report only modest reliability in staff agreement regarding a need for hospitalization. Because the decision to recommend hospitalization "is complicated and often difficult ... and involves the integration of factors that are both objective and subjective" (p. 72), Hendryx and Rohland concluded that further research is called for in this area.

Among the research in this area not specifically focused on American MHCs, Gutterman, Markowitz, Loconte, and Beier (1993) analyzed records of all children and adolescents screened at a mental health center during a 6-month period. Four factors predicted psychiatric hospitalizations: (a) the presence of both assaultive and suicidal behavior, (b) a substance use problem, (c) a parental or family member's substance use problem, and (d) a first/initial screening. Sederer and Summergrad (1993) reported that dangerousness, symptom severity, and inadequate client support systems predict the need for admissions. Hooten, Lyketsos, and Mollenhauer (1998) proposed a cutoff score of 39 on the Brief Psychiatric Rating Scale (Overall & Gorham, 1962) as an appropriate predictor for non-suicidal patients presenting at a psychiatric emergency department. Perhaps routine evaluations of clients' global functioning, coupled with a determination of how specific psychiatric symptoms have recently become more severe, can help MHCs predict the need for hospitalization admissions (Somoza & Somoza, 1993). …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Mental Health Counselors' Decision-Making Priorities Related to Inpatient Admissions for Anxiety Disordered Clients: A Pilot Study
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.