As we have seen, a crisis intervention service may obviate the need for hospital admission for some acutely disturbed people. Facilities such as day-centres, day-hospitals and hostels can make it possible for people to get assessment treatment or support without being cut off from all aspects of ordinary life. But some psychiatric patients need the surveillance, respite from stress and responsibilities, and intensive treatment that only an in-patient facility can provide. Without underestimating the risk of institutionalism, we should remember that many modern psychiatric wards bear little resemblance to the state hospitals described by Goffman (1961), and that stigmatisation can be as much a consequence of odd behaviour in the community as of mental hospital admission. The social worker can contribute in helping to reduce the ill effects, and maximise the benefits of hospital care. This chapter considers some aspects of social work that relate specifically to the psychiatric in-patient, and concludes with a brief discussion of the question of a hospital base for the specialist psychiatric social worker.
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