The Acute Non-Hospital: A California Model
Jolee Brunton, PhD
William Hawthorne, PhD

This paper, published in The Psychiatric Hospital in 1989 (Brunton, J. & Hawthorne, H. (1989). The Acute non-hospital: A California model. The Psychiatric Hospital, 20 (2), 95-99), and summarized below, describes five crisis residential programs in San Diego County, staff composition of the programs, clients, treatment model, and costs. The homelike settings of the crisis residential programs, which are located in or near residential neighborhoods, are designed to create a non-institutional therapeutic milieu. The more normalized setting created by the crisis residential treatment environment, with its absence of seclusion rooms and restraints, seeks to address the argument by some researchers that settings which protect and over-control may be harmful to the functioning of clients. The staff at the crisis residential programs are comprised of a multi-disciplinary team that includes a program director, consulting psychiatrist/medical director, consulting psychologist, nursing staff, social worker and mental health counselors. Staff are selected not only for academic background and experience, but for an attitude and treatment philosophy that is consistent with community-based, biopsychosocial, non-institutional treatment. In addition, attention is given to selecting a staff that is representative of, and knowledgeable about, the ethnic and cultural make-up of the community served by the program.

Admission criteria require the patient to be a voluntary adult in a psychiatric crisis severe enough to require psychiatric hospitalization. The patient cannot be actively violent or in need of restraints at the time of admission. Psychotic and acutely suicidal clients are assessed for appropriateness in an open setting prior to being admitted. The biopsychosocial model employed by the crisis residence provides the framework for a comprehensive, multi-disciplinary approach to treatment of mental disorders. Within this framework, the patient receives individual psychotherapy, group psychotherapy, task groups, art therapy, and recreation therapy. Treatment plans include linkage with community agencies and individuals that will provide ongoing care once the acute episode is resolved.