Inpatient Services of the Psychological Trauma Program

The inpatient service of the Department of Psychiatry of Mount Sinai Hospital is a 15-bed general psychiatry inpatient unit, part of the Joint General Psychiatry Program of Mount Sinai Hospital and the Centre for Addiction and Mental Health.

One of the 15 beds on the psychiatric inpatient unit at Mount Sinai Hospital is designated for planned admissions of patients suffering from severe psychological sequelae of traumatic events. These patients suffer from conditions which cannot be effectively diagnosed or treated on an outpatient basis.

Conditions range from severe post-traumatic stress disorder to dissociative identity disorder, often with a concomitant personality disorder or psychotic presentation complicating the clinical picture.

The admissions referred to are generally arranged to last for one week, from one Tuesday morning to the next Tuesday morning. Referrals for this program are coordinated by the Clinical Nurse Specialist, who then arranges for an interview in the Pre-Admission Screening Clinic with Dr. Edred Flak. At that time the suitability of admission for the patient is determined, and preliminary information-gathering from the patient is initiated.

Conditions of acceptance into the program include the following:

• Continuing involvement in ongoing outpatient psychotherapy.
• Previous assessment by a psychiatrist.
• Freedom from use of alcohol and non-prescribed drugs or medication for the two weeks prior to the admission, for the period of time in hospital, and for at least two weeks following the admission.
• Maintenance of physical safety without harm or threat of harm to self or others for the two weeks prior to the admission, for the period of time in hospital, and for at least two weeks following the admission.
• A suitable focus for inpatient intervention, i.e. one which cannot be effectively dealt with on an outpatient basis and which is more likely to be resolved in an inpatient setting using specific interventions and shift-to-shift support.

We encourage the patient’s outpatient therapist to meet with the team and to sit in on psychotherapeutic interventions. When this is not possible, we can usually videotape at least one session with a patient, and send this videotape back with the patient to the outpatient therapist at the end of the admission. It is often much more explanatory and useful to demonstrate a technique than to describe it.

What the Inpatient Trauma Program Does Not Offer

This program offers a variety of specific interventions within a limited framework: admissions are elective and planned; they generally last for exactly one week; they are aimed at psychotherapeutic resolution of already-identified problems, with outcome goals that are decided in advance.

These brief admissions cannot resolve the long-standing maladaptive patterns maintained by a severe personality disorder, although they can help patients and therapists resolve therapeutic blocks that require specialized techniques and/or continuous support in a safe setting.

The program is also not designed to provide crisis intervention. To protect the integrity of the program and to avoid giving mixed messages to our patients and their outpatient therapists, when patients are in crisis that requires hospitalization, we ask that they attend their home-base hospital emergency department, and that admission be undertaken at that hospital, rather than at Mount Sinai Hospital.

Because the focus of the admission is psychotherapeutic, medication consultation and medication changes should be undertaken on an outpatient basis, with the medication regimen stabilized prior to admission to the inpatient trauma program. Similarly, any acute medical conditions that require active interventions should be stabilized prior to admission to the inpatient trauma program.

Violations of the conditions of the program as described above lead to postponement of admission, or if the violation occurs during the course of the admission, then discharge from the unit as soon as can safely be arranged, will follow. We recognize that sometimes successful participation for even part of the week can be useful. Early termination of the admission will not jeopardize the possibility of future admissions.

How to Refer Patients to the Inpatient Trauma Program

Outpatient therapists can make a referral to the program through the Clinical Nurse Specialist on 9-South by telephoning 416-586-4800 ext. 2619.

Information to be sent along with the referral form for admission form include psychiatric evaluation and signed Form 14’s for any prior hospitalizations and/or other consultations. Upon completion, it should be returned by mail, or faxed to 416-586-3149, in care of:

Psychological Trauma Program, Inpatient Section
Department of Psychiatry
Mount Sinai Hospital
Attention Clinical Nurse Specialist

Any other information the referring therapist thinks could be helpful should also be sent at that time. After the necessary information has been received, the referring therapist and/or patient will be contacted by our Clinical Nurse Specialist, who will arrange a time for a Pre-Admission Screening Clinic assessment. This is when the suitability and terms of admission will be decided.

If appropriate, the dates of the one-week elective admission will be decided during the Pre-Admission Screening. The outpatient therapist is encouraged to attend the Pre-Admission Screening Clinic interview.

Any questions about the program can be directed to Nathalie Peladeau, Clinical Nurse Specialist at 416-586-4800 ext. 2619.

Leadership

The Inpatient Section of the Psychological Trauma Program in the Department of Psychiatry at Mount Sinai Hospital is led by:

• Clinical Director: Edred Flak, MD, FRCPC
• Associate Clinical Director: Paul Vrooman, MSW, RSW

Location and Contact Information

Psychological Trauma Program Inpatient Section
Department of Psychiatry
Mount Sinai Hospital
Joseph and Wolf Lebovic Health Complex
600 University Avenue, 9th Floor - South Wing
Toronto, ON  M5G 1X5
Phone: 416-586-4541
Fax: 416-586-3149