HJAR Nov/Dec 2019

DIALOGUE 10 NOV / DEC 2019 I  HEALTHCARE JOURNAL OF ARKANSAS   Chief Editor Smith W. Hartley As the only state operated acute psychiatric inpatient hospital, what does that mean for Arkan- sas State Hospital (ASH), and how does it differentiate from other psychiatric hos- pitals in Arkansas? Jay Hill While Arkansas State Hospital is licensed as an acute psychiatric hospital, it has the only dedicated forensic inpa- tient acute services in the state. As a state- operated facility, when a patient is court- ordered into the custody of DHS, Arkansas State Hospital is the only psychiatric hospi- tal in the state that cannot refuse admission, and treats patients regardless of payment source. When a person has no payment source, or if other psychiatric facilities refuse admission due to some other rea- son, such as treatment resistance, chronic- ity, extreme behavioral issues and aggres- sion, persons may be ordered specifically to ASH. Due to the nature of the court orders we receive, court processes, level of treat- ment resistance, and difficulties finding less restrictive placements for our patients, the length of stay at ASH tends to be longer (sometimes years) than in other inpatient psychiatric acute hospitals. Editor Can you tell us about the services and number of beds at Arkansas State Hospital? Hill Forensic treatment is much the same as general psychiatric treatment performed in other psychiatric facilities, with two main differences: 1. Arkansas State Hospital accepts patients regardless of the nature of charges and the degree of aggres- sion or predatory behaviors they may exhibit. 2. ASH presents a curriculum to patients with forensic treatment orders that is aimed at restoring them to fitness (helping them understand the court process sufficiently to assist their attorney in their defense). Otherwise, ASH utilizes the same types of medications, individual, family, group, milieu, and recreation therapies used by other psychiatric hospitals. Hill Arkansas State Hospital has 222 total beds, of which 186 are adult beds, and 36 are adolescent beds. For adults, there are five dedicated forensic units with 126 beds total. Three of these units are all-male units. For adolescents, there is an 18-bed male sex offender unit and an 18-bed co-ed general psychiatric adolescent unit. Many of the patients in the general unit are adolescents with forensic court orders. The remainder are almost exclusively patients who have severe behavioral issues (most often severe aggression), which has resulted in numer- ous placements, often resulting in the inabil- ity to find additional placement and treat- ment at other psychiatric facilities. Editor What can you tell us about your forensic service area, and some of the models you use for success?

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