University Psychiatric Centers – Detroit Receiving Hospital

The High Intervention Program is on the Central Campus of DRH. The Medical Director of the program is Alireza Amirsadri, M.D.

This clinical program consists of two different but interconnected programs (Crisis Center and Intensive Care Inpatient Psychiatry) in Detroit Receiving Hospital. HIP serves a unique population of patients who are high risk and suffer from wide ranges of illnesses from severe personality disorders to the ones who are highly aggressive and agitated or have acute suicidal ideation with multiple comorbid illnesses in addition to their acute or chronic social problems.

Psychotic disorders, severe mood disorders with or without psychosis, and diagnosis related to substance use are among the most common illnesses assessed, treated and stabilized at HIP.

The Crisis Center (Psychiatric Emergency Room) the 24/7 arm of HIP, is adjacent to a very busy Trauma Center. Victor Ajluni, M.D. is the Associate Medical Director. One of the busiest crisis centers in the country, in addition to1200 consults for the medical emergency room, serves more than 10,000 patients in a year.

Through implementation of different levels of care and assertive individualized treatment implementation, this crisis center has succeeded to reduce its inpatient admission rate to less than 26%.

Patients in this service not only are treated for their psychiatric illness but their medical illnesses and social problems are addressed in the best possible available way. ‘Continuous best’ describes the relationship between this service and other medical specialties like internal medicine and emergency medicine.

Patients arrive in this service via EMS, Police, group home providers, lower level treatment program staff, families, etc. Patients who meet criteria for inpatient hospitalization may be transferred to any of the other hospitals in the area. Many of the patients with SMI who do not go to hospitals might be transferred to Transitional Housing Facilities secondary to being homeless.

Treatment Team Composition: Crisis Center has on-site availability of a psychiatrist 24/7. In addition, secondary to the volume and teaching responsibilities, a second psychiatrist provides care for about 8 to 10 hours a day. In addition to nurses, social workers, mental health technicians, psychiatry residents, psychology interns, physician assistant and medical students also take are part on this team. Emergency medicine, internal medicine, dietitians, and other consultants are available on as needed basis.

Education, training and research: Psychiatry residents, psychology interns, physician assistants, year two medical students and social work students rotate through this service.

Multiple clinical or epidemiological research projects are conducted through this center by HIP or other faculty staff of DPBN.

The Intensive Care Inpatient Unit is located on the third floor of Detroit Receiving Hospital. The Associate Medical Director is Ramesh Jasti, M.D. This locked unit has 19 acute beds with private and semi-private rooms. Although most patients are voluntary, a lower percentage of patients have involuntary status.

Within this highly structured setting a multidisciplinary approach is implemented using different modalities such as: medication management, detoxification, individual and group therapy, occupational therapy, psychoeducational meetings, family therapy as well as exercise and music groups. Spiritual counseling is also available upon request or need.

Patients 18 and older with a diagnosis of a severe psychiatric illness with higher level of intensity are admitted to this program. Although most patients come from the crisis center, a good number of them are transfers from medical surgical units from Detroit Receiving, Harper University or Hutzel Women Hospitals or Karmanos Cancer Insitute and Rehabilitation Institute. Some patients are transferred from outside the system hospitals.

Treatment Team Composition: In addition to the attending psychiatrists who have their daily rounds and conduct their treatment team meetings, members of nursing staff including an advanced practice nurse, social workers, occupational therapists, spiritual, dietary, pharmacy and medical consultants participate in the assessment and treatment management of patients. When available psychology interns, psychiatry residents, medical, nursing and physician assistant students are also participants.

Training, education and research: Periodically psychiatry residents, psychology interns and medical students as well as social work and nursing students have clinical rotations in this unit.

Different clinical studies are under consideration for this program.

Medical Psychiatry (Consultation- Liaison Psychiatry) in the central campus treats psychiatrically ill patients on medicalsurgical floors in Detroit Receiving, Harper Univesity, Hutzel Women hospitals as well as Rehabilitation and Karmanos Cancer Institute. The clinical team also assesses and treats patients in some specialty clinics such as HIV or Transplant programs.

Their daily rounds does not only consist of assessment, medication management, psychotherapeutic interventions, assessing for proper disposition and referral, patient followups or discussion with their families and friends but also a proactive effort in educating all other medical teams directly and indirectly through participation in their team meetings, going to their morning reports and or one-toone interactions. The Medical Director is Thomas Kuhn, M.D.

Treatment Team Composition: Two psychiatrists, a PhD psychologist, and two advanced practice nurses are the permanent members of this busy service. In addition, as part of their clinical rotations, psychology interns, physician assistant and medical students participate as team members during their educational experience.

Education and training: Psychology interns, physician assistant students and medical students rotate through this service. Psychiatry residents can spend an elective time in this service.

The Inpatient Psychiatry Unit at Madison Behavioral is a locked unit. The Medical Director is Luay Haddad, M.D. This 30-bed acute unit accepts both voluntary and involuntary patients from different referral sources.

A multidisciplinary team approach within a therapeutic milieu is implemented for all days of the week. Psychiatric assessment, medication management, medical management, psychoeducation meetings, individual, group, and occupational therapy as well as treatment team and family meetings are all parts of this treatment program.

Patients 18 and older are admitted to this unit; however emphasis is mostly on admission of younger individuals. All psychiatrically ill patients with reasonable medical stability who meet a higher level of care in a structured setting are potential candidates for this program.

Treatment Team Composition: Psychiatrists, medical consultants, nurses, social workers, mental health technicians and student nurses are part of the treating team in this facility.

Training and education: At this time, only nursing students are assigned to this program.