Medical psychiatry units: Improving their organization, focus, and value

Medical psychiatric units are hospital inpatient wards aimed at patients with physical and mental disorders, a combination that is common, especially in hospitals. For clinically admitted hospital patients, mental illness is associated with a longer length of hospital stay (LOS), higher medical costs and more readmissions. MPUs focus on the one hand on facilitating medical treatment, and on the other hand on restoration of functioning and quality of life. It is also often emphasized that they have the potential to reduce length of stay, costs and readmissions. Medical and psychiatric diagnoses of patients in these wards are wide and varying. Providing acute medical care creates a field of tension with more process-oriented treatment. There are approximately 40 MPUs in the Netherlands, largely located in psychiatric wards. The majority of these departments can treat patients with an average to high level of care. In the Netherlands, quality indicators for this care were proposed in 2014 and expanded in this thesis. The dissertation further investigates which factors influence the decision to admit patients to an MPU. Finally, it maps the target group of a new MPU to be established in an academic setting. In the future, MPUs should target even more people with severe psychiatric illness, who are known for their poor medical outcomes. This dissertation forms a basis to optimize the organization of MPUs by linking aims to structure and process characteristics. In the future, the different types of MPUs may facilitate outcome research.

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