Organization of Psychosocial Care in a Teaching Hospital

This paper describes a method of organizing the psychosocial aspects of medical care in a new teaching hospital. An attempt is made to prevent some of the problems in care identified by the Duff and Hollingshead study (8). In order to be effective, however, psychiatrists must take major steps to overcome their marginal position in the medical profession. In addition, education of medical students to comprehend and manage psychosocial problems must begin at the outset of their medical educational experience and continue throughout. These are the prerequisites for a program of psychosocial care which then faces a major organizational challenge: to transfer aspects of psychosocial care from psychiatrists to others. Ordinary problems of living as distinct from psychiatric problems should not be referred to psychiatrists. In order to accomplish this aim, stable organizational structures ramifying throughout the health care system will be required. Such structures must support informal relationships based on personal respect and the achievements of good education. Psychosocial care in teaching hospitals is not likely to improve until it has representation in the power structure of the institution. Specific goals and methods of organizing psychosocial aspects of medical care are outlined.