Use this rubric to create annotated bibliography using these sources make sure it’s in apa forma Al-Rubaie A. (2025). Traumatic brain injury and dementia: Mechanisms, risk stratification, an

Annotated Bibliography

Jessica Kacinski

Katherine Raynor

Human Services Theory & Practice III

21 March, 2023

Frueh, B. C., Dalton, M. E., Johnson, M. R., Hiers, T. G., Gold, P. B., Magruder, K. M., & Santos, A. B. (2000). Trauma within the psychiatric setting: Conceptual framework, research directions, and policy implications. Administration and Policy in Mental Health, 28(2), 147-154.

Frightening, distressing, and potentially traumatizing experiences appear to be common in the psychiatric setting, but the majority of these instances were recorded anecdotally, whereas reliable, empirical observations and results are scant in the available research. Individuals with prior histories of trauma may be particularly vulnerable to the inpatient setting, exacerbating PTSD symptoms and/or being at a higher risk for re-traumatization. Regardless of prior trauma history or lack thereof, patients admitted to the inpatient unit are an especially vulnerable population. Healthcare administrators and providers as well as policymakers would do well to take extreme care in formulating and/or adjusting existing service provisions and their manner of delivery, being sensitive to their consumer population. More research in the prevalence, perceptions, and consequences of distressing and/or traumatic experiences on the inpatient unit would do much for future policy considerations.

Though accounts of experienced trauma in psych wards still remain largely anecdotal as opposed to empirical in available studies, certain indicators, like the revolving door phenomenon (RD), have been increasingly used as an indicator for quality of care (Kumar et al., 2002; Niehaus et al., 2008; Vandereycken, 2011). Whereas Frueh et al. gives 4 specific case study examples to show traumatic experiences exist at the inpatient level, Simonson (2018) supports the same claim with its study that uses a much larger pool of respondents (n=486), though both remain significant and reinforce each other’s findings; both highlight the overuse of coercive practices (i.e., forced medication, restraint and seclusion) and the occurrence of sexual assault (whether by staff members or other patients). Frueh et al. (2000) also highlight how traumatic experiences can result in patient reluctance to engage in follow-up care after discharge, which is supported by Niimura et al. (2016) and has major implications for those affected.

Glick, I. D., Sharfstein, S. S., & Schwartz, H. I. (2011). Inpatient psychiatric care in the 21st century: The need for reform. Psychiatric Services (Washington, D.C.), 62(2), 206–209.

The ultra-short length of stay ( LOS ) model for acute psychiatric inpatient care reduces the chances for sustained recovery, and the push for such ultrashort LOS is driven largely by financial pressures (Glick et al., 2011). Literature from the 1970s and 1980s often seems to suggest shorter stays in hospitals are better than longer ones, but the previous definitions of “short stays” would be considered long stays today, whereas the ultrashort model that is now prevalent seems to be too harmful . Today, acute hospital stays are geared towards crisis stabilization; measures taken to reduce safety risks posed by hospital environments have contributed towards prison-like atmospheres that can have lasting psychological effects on patients who are already in a vulnerable state. When hospital stays were longer, there was value in observing patients before they were medicated, to dedicating more time to gather more complete and holistic patient histories, and to ensuring smooth and manageable transitions to outpatient care post-discharge, but the current rush to discharge patients means that treatment decisions must be made quickly and thus these things are no longer possible with the current model. The authors note this change occurred not because there was evidence suggesting previous practices were ineffective, but because with the ever-increasing presence of insurance companies in the psychiatric sector, insurance providers became increasingly unwilling to pay for what they deemed as unnecessary extra hospital time. Suggestions are given by the authors for what should be guiding principles for determining a more appropriate LOS, which are more culturally sensitive and person-centered. Authors acknowledge the challenges the current model poses to sustained recovery while also acknowledging the necessity of having inpatient treatment options.

The needle has been pushed too far from one extreme to another; from patients spending

years of their lives in institutions prior to deinstitutionalization to spending mere days thus reducing the chances for quality care. Ultrashort patient stays at the time of this article’s publication were approximately 5 or 6 days, and these averages are similar to those reported elsewhere, though, variations do exist depending on the unit (Niimura et al., 2016). Also supported by other studies is the emphasis on person-centered care in psych wards, that a one-size-fits-all approach simply does not always work and certain people may benefit from unit experiences differently than others (Vandereycken, 2011; Niimura et al., 2016).

Kumar, Robinson, E., & Vinod Kumar Sinha. (2002). What leads to frequent re-hospitalisation when community care is not well developed? Social Psychiatry and Psychiatric Epidemiology, 37(9), 435–440.

This study’s results show that the factors contributing to the revolving door phenomenon (RD) may differ between developed and developing countries. Being able to more accurately identify which groups of patients may be at a greater risk for re-hospitalization can allow specific interventions to be directed to them to hopefully reduce readmissions. Authors claim this to be the first study done in analyzing re-hospitalization in India, which offers a unique and significant perspective, but also should warrant some caution in making generalizations from this article, at least until results can be confirmed by other studies. It is also important to note that the sample size may be a comparatively small (n=90 for total included cases, n=17 for frequently re-hospitalized patients (FR)), and is extremely niche; the researchers excluded patients from the study for a large variety of reasons, not least of which include if the patient was over the age of 45, if substance abuse was present, or if the patient was admitted involuntarily. However, the implications of the results of this study are significant. The main predictive factors for RD in this study were degree of perceived social support for treatment, days spent in the hospital during admission, and type of living community (i.e., rural, suburban, urban).         

Kumar et al., claim that one of the leading protective factors against readmission is that of adequate social support, and this finding has interesting implications, specifically for individuals on eating disorder units. Vandereycken (2018) implies that inpatient units specializing in eating disorders can cause more harm than good, specifically because of the lack of adequate support between inpatients. Eating disorder “culture” can be competitive, therefore lending to a difficult road to recovery when one is trying to get well when in crisis and is surrounded by other people struggling with eating disorders. If poor social support is a risk factor for readmission (even if Kumar et al.’s study is specific to developing countries) and a person’s social surroundings on an eating disorder unit may be less-than supportive, this leads to questions as to whether an inpatient unit specific for people just with eating disorders is the most appropriate setting conducive to recovery.

Lamb, H. R., & Weinberger, L. E. (2005). The shift of psychiatric inpatient care from hospitals to jails and prisons. The Journal of the American Academy of Psychiatry and the Law, 33(4), 529–534.

Authors highlight the implications of shortages of psychiatric beds and how such shortages have been at least a partial cause to the increased number of mentally ill individuals in jails and prisons. The necessity for psychiatric inpatient care is acknowledged, as shown by the overtaxed hospitals that are continually having to make decisions on who gets admitted and for how long, leaving many who are acutely in need of treatment either turned away or prematurely discharged. Some of those individuals who do not get the proper care they need, whose needs cannot be met in the community, and are at risk of hurting themselves or others may come into contact with the criminal justice system and subsequently be imprisoned. In less than 50 years from when the deinstitutionalization movement was kicked into high-gear in the United States (which was around the mid-20th century), the number of available state mental hospital beds dropped from 559,000 to 59,403. Compare this to the amount of prison inmates from 1978 to 2000, and you have a significant increase in inmates from 465,760 to a striking 1,937,482. The priorities of state and local mental health departments are noted as perhaps being unbalanced, with the funds available being allocated to outpatient programs instead of increasing bed capacity, despite the evidence that some people in mental health crises cannot be adequately treated in an outpatient setting. Authors strongly urge that more attention be given to psychiatric inpatient units in order to relieve the amount of inpatients that are currently inmates, and suggest that doing so may even be less costly in the long-run. 

Along with the observation of a transinstitutionalization phenomenon, other studies, along with this one, have also pointed to observations that prisons and psychiatric wards are quite similar to each other in some ways. Dehumanizing environments due to safety concerns are often found, lending to a more prison-like atmosphere (Glick et al., 2011). Adverse experiences of punishment, physical and sexual assault, are also found in both (Frueh et al., 2000; Simonson, 2018). Inpatients seem to frequently be treated as inmates, being on locked wards with their rights often not respected (Simonson, 2018), lending to further psychological harm for an already extremely vulnerable population (Frueh et al., 2000).

Niehaus, D. J., Koen, L., Galal, U., Dhansay, K., Oosthuizen, P. P., Emsley, R. A., & Jordaan, E. (2008). Crisis discharges and readmission risk in acute psychiatric male inpatients. BMC Psychiatry, 8, 44.

Authors sought to determine the effects of crisis discharge policies on the readmission risks for acutely psychotic male inpatients at the Stikland Psychiatric Hospital in South Africa. It was found that  45% of crisis discharges were readmitted to the inpatient setting during the 2 ½ years of the study, compared to a 31% readmission rate of non-crisis discharges in the same time period, showing support for their claim that crisis discharges have an exacerbating effect of the revolving door phenomenon. Crisis discharge policies were adopted in parts of South Africa to address the severe bed shortages faced by the psychiatric sector. Criteria for what constitutes a “crisis discharge” is clearly highlighted and is, in addition to the authors’ results and analyses, repeatedly cited in the broader literature regarding this topic. Shortening inpatient lengths of stay (LOS) have been supported by prior studies that showed no difference in readmission risks for shorter versus longer inpatient stays (a common predictor of quality of inpatient care), however, conflicting evidence exists. Average LOS for all admissions in this study was 43.9 days–significantly longer than what is typically termed as an “ultrashort LOS” in acute hospital wards in America today, though that also varies. In addition to a higher rate of readmission, the crisis-discharge group is also more likely to be readmitted sooner after discharge than the non-crisis discharge group, giving more evidence that suggests that crisis discharge policies can exacerbate the revolving door phenomenon. Increasing bed capacity in the psychiatric sector should be seriously considered to reduce the incidence rates of crisis discharges and the need for such policies in general. 

Formal recognition or identification of crisis-discharge policies does not seem to be too widespread in the literature, but more informal acknowledgements of discharging patients prematurely due to bed pressures are (Lamb & Weinberger, 2005; Glick et al., 2011). Capacity pressures force hospital staff to prioritize which patients to admit and which ones they may have to turn away or discharge prematurely, giving way to a possible transinstitutionalization effect for those in crisis that may come into contact with criminal justice personnel (Lamb & Weinberger, 2005), or a revolving door effect because not enough time was given for inpatients to properly stabilize before being discharged (Glick et al., 2011; Kumar et al., 2002). Many of the authors addressing premature discharges emphasize the need for more attention on inpatient care, specifically regarding increasing bed capacity (Glick et al., 2011; Lamb & Weinberger, 2005).

Niimura, J., Tanoue, M., & Nakanishi, M. (2016). Challenges following discharge from acute psychiatric inpatient care in Japan: patients' perspectives. Journal of psychiatric and mental health nursing, 23(9-10), 576–584.

In acknowledging illness recurrence and readmission to acute psychiatric wards in Japan, 

the authors sought to gain patient perspectives on in-hospital and transitional care

post-discharge for those who were involuntarily admitted and given a diagnosis of 

schizophrenia spectrum disorder. Eighteen patients were interviewed between 1 and 6 

months following their last psychiatric discharge and asked questions regarding both their 

inpatient and present experiences. Some participants were able to make positive 

meanings out of their inpatient care, however, the majority of the study focused on the 

more negative aspects of participant experiences. Patients expressed that discontinuity in 

care and side-effects of psychotropic medications following hospitalization presented 

significant challenges, as well as a combination of factors during hospitalization that had 

significant impacts on post-discharge life, such as: inaccessibility to and perceived stigma 

from support staff; not being included in care decisions; and negative acceptance of

hospitalization (i.e. denial, feelings that their hospitalization was unjustified or 

unnecessary, etc.). A number of patients noted that waking up and fulfilling their 

expected roles in society was more difficult post-discharge than before their 

hospitalization, highlighting the need for hospital reform and better transitional care. 

Some participants noted that their wishes regarding their medication management were 

ignored, even when their current treatment was not working, and this led to feelings of 

hopelessness, helplessness, and a reluctance to engage with treatment and help-seeking 

behaviors in the future, further emphasizing the need for reform. Fears of 

rehospitalization were also present, and participants acknowledged that this impacted 

their comfortability in being frank about their experiences. 

Fortunately, despite the overwhelming evidence of negative experiences in psychiatric wards, this study and others do show that not all inpatient experiences are harmful, and truly can save lives, emphasizing further the necessity of inpatient care. Many are able to capitalize on supports of fellow inpatients going through similar experiences (Vandereycken, 2011), and 32% of respondents in one study said that their psych ward admission saved their life. (Simonson, 2018). Niimura does note that some patients were able to make a positive meaning out of their inpatient admission, and even some of those who were discharges (Niehaus et al., 2008), many were able to not become victim to the revolving door phenomenon, showing that sustained recovery is certainly possible. 

Simonson, M. (2018, December 9). MIA survey: Ex-patients tell of force, trauma and sexual abuse in America's mental hospitals. Mad In America.

Nearly 500 respondents share their prior experiences of trauma from psychiatric inpatient stays, with the majority of respondents having their most recent hospitalization occur in the 2010s. Concerning statistics are provided on the incidence rates of physical punishments or abuse that were perceived to be unjustified–including being forcibly drugged and sexually abused; approximately 37% of all study participants experienced some form of punishment or abuse themselves. When participants were asked if they felt safe and secure on the ward, more than half of respondents either disagreed (20%) or strongly disagreed (36%). The vast majority of participants (84%) had hospital stays of a month or less (38% of all participants had stays lasting less than one week). Perhaps of most concern was that of all patients, 68% considered their psych ward experience to be traumatic. Interestingly enough, however, when asked if participants would recommend inpatient treatment to a mentally ill loved one, 62% replied either “Yes” (16%), or “Only If Emergency” (46%), highlighting an interesting paradox that despite the oftentimes traumatic nature of psych ward experiences, many still recognize that inpatient care can be necessary. It is important to note that the study’s results came from respondents who chose to answer the questions and did not involve a random sampling of former inpatients. However, authors claim that the survey findings have been confirmed by a number of investigations and reports. 

This study essentially reinforces the data from the other ones before mentioned; they all speak of some traumatic or harmful experience from inpatient psychiatric care and/or some important problem within the system, with a combination of empirical and anecdotal evidence. The inspiration for this thesis is grounded in this article–specifically that although so many inpatients deem inpatient care as traumatic, there is simultaneously about the same percentage of patients that claim that the existence of inpatient care is important. Other studies claim this as well, but those claims come from the researchers and authors (Niehaus et al., 2008; Lamb & Weinberger, 2005; Frueh et al., 2000; Glick et al., 2011; Kumar et al., 2002), whereas in this article it comes directly from the patients, providing invaluable insights.

Vandereycken W. (2011). Can eating disorders become 'contagious' in group therapy and specialized inpatient care?. European Eating Disorders Review: The Journal of the Eating Disorders Association, 19(4), 289–295.

Vandereycken (2011) examines the existing literature for the so-called “peer-contagion” effect on inpatient eating disorder units, the phenomenon that describes how the sick get sicker on inpatient units due to their interactions with other inpatients. Patient opinions as to the benefit of treatment on units with other individuals with eating disorders are mixed; having people who are going through the same struggles offers an important and unique source of support–including in supporting one another in working to get well–and simultaneously, can be extremely detrimental, as patients may pick-up harmful habits from each other and compete to be the “best” at their eating disorder. Vandereycken points to a harmful subculture within the broader eating disorder community, one that is fraught with shaming each other and other types of bullying towards those who don’t restrict their caloric intake enough, or partake in other weight-loss tactics at a frequency or intensity that others do. This rivalry and competition specific to this group of diagnoses brings up questions as to if inpatient treatment is the most appropriate place for individuals with such struggles.

An important question to grapple with based on the results of this study that can have significant implications for future policy considerations is: Do the benefits of group psychiatric inpatient care outweigh the harms of the contagion effect? This can be extended more broadly to, do the benefits of inpatient care outweigh the harms of it in general? Answers to this question are mixed, but Simonson (2018) presents a compelling argument that the benefits, in fact, do outweigh the harms; even though the inpatient experience can oftentimes be harmful and/or traumatic, many people still find it necessary. Therefore, solutions have to be explored in order to not abolish the system completely, but to improve it. When applied to Vandereycken (2011), it may be that eating disorder-specific units are not the most healing environment, and that people with mixed diagnoses should sometimes be grouped together, if appropriate. Better still, is if a person-centered approach is taken, as suggested by Niimura et al. (2016) and Glick et al. (2011).

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