Medical Psychiatry Unit Consortium
What is a medical psychiatry unit?
MPUs, also known as Complexity Intervention Units (CIUs), were created to deliver optimum acute hospital care to patients who have concomitant medical and psychiatric needs. Due to their trans-disciplinary nature, MPUs are also an ideal venue for engaging patients in the services they may be struggling to navigate in a fragmented health-care system.
MPU Consortium Goals
The primary mission of the MPU consortium is to bring together clinicians, educators and scholars working on Medical Psychiatry Units to exchange experiences and collaborate on new initiatives to improve outcomes for patients with complex needs.
History of the MPU Consortium
The Association of Medicine and Psychiatry has always been a gathering place for clinicians working at the intersection of medicine and psychiatry including MPUs. Members of the Association of Medicine and Psychiatry, including pre-eminent scholar of MPUs, Dr. Roger Kathol, have been strong proponents of their value and dual-boarded physicians are ideally trained to work on and run MPUs. Yet, despite evolving evidence of the benefits of MPUs, most MPUs developed in isolation of one another with little concerted effort for organizing data or outcomes across institutions. The MPU consortium aims to change this.
MPU Clinicians and Scholars Recognized a Need for Collaboration
The first meeting was the result of a series of discussions between several AMP members who had an interest in studying and disseminating data related to the value of MPUs. Current MPU consortium chair, Dr. Marsha Wittink, met with Dr. Roger Kathol in 2018, who subsequently introduced her to MPU study group members, Dr. Maarten van Schijdel and Dr. Ashley Ellison. The international MPU study group was conducting a survey to assess the prevalence of MPUs across the United States. The idea of convening a group at the AMP meeting began to coalesce in these discussions. AMP member Dr. Aubrey Chan was also part of the initial team of organizers, having recently published a paper in Annals of Internal Medicine describing 5 MPUs across the US. (Chan et al., 2018)
The Inaugural MPU Consortium Meeting
The first MPU consortium meeting was held during the 2019 AMP conference in Atlanta Georgia. Nearly 60 conference attendees joined the reception and brainstormed about experiences on MPU and ways to collaborate and collect data.
Among those in attendance was Dr. Vicki Kijewski, the medical director of the first known MPU in the US at the University of Iowa. Dr. Kijewski and Dr. Telva Olivares (Director of Medicine and Psychiatry Services at the University of Rochester) talked about their well-oiled units and some of the many things they have learned about running successful units along the way. Both physicians have been incredible resources over the years for others interested in developing MPUs.
Other AMP members, including Dr. Susan Padrino and Dr. Brad McConville, talked about the challenges and successes of building their new units at University Hospitals of Cleveland (Ohio) and Tulane University respectively. Other AMP members who were in various stages of thinking about starting MPUs joined the meeting from Kalamazoo, University of Texas, UC Davis, SUNY Downstate, Augusta University, Cincinnati, St. Louis University, Southern Illinois University, University of Kentucky and Wisconsin.
The first actionable item that resulted from the meeting was the creation of an email list-serv to continue conversations virtually. Soon after, we created a Google Drive folder to collect resources, relevant publications and clinical protocols (see below). We are excited to continue to develop the consortium and welcome new members. We will plan to have a virtual meeting for the next AMP meeting in 2020 that has been moved online.
Past Projects
AMP Webinar (2021), Thinking about starting a Medical-Psychiatry Unit (MPU)?: Lessons learned from 3 MPUs and the MPU consortium.
26th World Congress of the International College of Psychosomatic Medicine (ICPM) Symposium (2022), Improving Medical Outcomes for Patients with Severe Mental Illnesses: Comparison of Three Medical-Psychiatric Units in the United States
Abstract published in Psychother Psychosom 2022;91(suppl 1):3-40 DOI: 10.1159/000526562:
https://web.archive.org/web/20221004035040id_/https://www.karger.com/Article/Pdf/526562
Position Paper: The Undervalued Potential of Medical-Psychiatry Units to Improve Care for People with Severe Mental Illnesses. Psychiatric Services (2023)
https://pubmed.ncbi.nlm.nih.gov/36820518
Association of Medicine and Psychiatry Annual Meeting Workshop, Milwaukee (2023):
Identifying Patient-Centered Outcomes for Integrated Care Across the Continuum
Current Projects
MPU Consensus Project
What are the essential qualities of an MPU? What features are must-haves, and what things are optional and customizable? The MPU Consortium is currently recruiting experts from diverse disciplines and experiences to produce a formal consensus document of what makes an MPU.
MPU Operating Characteristics
A major hurdle for those interested in founding an MPU is administrative buy-in and ensuring financial viability and sustainability. The MPU Consortium is collaborating on a project describing several independently-established MPUs. This project will describe patient populations served by these MPUs, common diagnoses, and performance metrics like length-of-stay, discharge disposition, and readmission rates.
Future Projects
The MPU Consortium already has several future projects planned, such as measuring quality, safety, and performance metrics on MPUs compared to conventional inpatient units at the same institutions, measuring the prevalence of patients well-suited to MPUs and demand for MPU beds, and future interventional studies to determine how MPUs can contribute to improving longitudinal care for people with severe mental illnesses.
Resources
This link includes folders with information about admission criteria, presentations about MPUs and protocols from existing MPUs:
https://drive.google.com/drive/folders/1JJ4o-SytV1aCsAInDB0NNRMUUqCOHt4O
MPU Manual (in progress):
https://myweb.uiowa.edu/acchan/Tome.html
Papers of Interest
Organization and Outcomes of Integrated Inpatient Medical and Psychiatric Care Units: A Systematic Review. M.A. van Schijndel, J.D.H. van Wijngaarden, J.J. van de Klundert. Psychiatric Services. Jan 2022.
— https://doi.org/10.1176/appi.ps.202000416
Medical Psychiatry Units: Improving their organization, focus, and value. M.A. van Schijndel PhD dissertation, Sept 2020.
— https://repub.eur.nl/pub/131221/MvS-proefschrift-binnenwerk-zh2.pdf
Taking the Long View in an Inpatient Medical Unit: A Person-Centered, Integrated Team Approach for Patients With Severe Mental Illnesses. M.N. Wittink, W.Cross, et al. Psychiatric Services. Sept 2020.
— https://doi.org/10.1176/appi.ps.201900385
Factors influencing the admission decision for Medical Psychiatry Units: A concept mapping approach. P.J. Caarls, M.A. van Schijndel, et al. PLoS One. Sept 2019.
— https://doi.org/10.1371/journal.pone.0221807
Towards integrated medical and mental healthcare in the inpatient setting: what is the role of psychology? L.R. Pudalov, M.T. Swogger, M. Wittink. International Review of Psychiatry. Dec 2018.
— https://doi.org/10.1080/09540261.2018.1552125
Integrated Inpatient Medical and Psychiatric Care: Experiences of 5 Institutions. A.C. Chan, C.A. Burke, et al. Annals of Internal Medicine. June 2018.
— https://doi:10.7326/M17-3186
Closing the Mortality Gap — Mental Illness and Medical Care. L. Rosenbaum. New England Journal of Medicine. Oct 2016. 375;16:1585.
— https://www.nejm.org/doi/10.1056/NEJMms1610125
Co-managed Care for Medical Inpatients, C-L vs C/L Psychiatry. P.R. Muskin, A. Skomorowsky, R.N. Shah. Psychosomatics. May-June 2016.
— https://doi.org/10.1016/j.psym.2016.02.001
Integrated Models of Care for Medical Inpatients with Psychiatric Disorders: A Systematic Review. M. Hussain, D. Seitz. Psychosomatics. July-Aug 2014.
— https://doi.org/10.1016/j.psym.2013.08.003
The Hennepin County Medical Center Program in Medical Psychiatry: Addressing the Shortened Lifespan of Patients with Mental Illness. M. Linzer, M.K. Popkin, E. Coffey. Journal of General Internal Medicine. March 2013.
— https://doi.org/10.1007/s11606-012-2325-9
The rewards and challenges of treating psychiatric patients. B. Darves. Today's Hospitalist. June 2012.
— https://www.todayshospitalist.com/the-rewards-and-challenges-of-treating-psychiatric-patients
Barriers to Physical and Mental Condition Integrated Service Delivery. R.G. Kathol, M. Butler, et al. Psychosomatic Medicine. July 2010.
— https://journals.lww.com/psychosomaticmedicine/Fulltext/2010/07000/Barriers_to_Physical_and_Mental_Condition.1.aspx
Cost outcomes on a medical psychiatry unit. R.G. Kathol. Journal of Psychosomatic Research. Mar 2010.
— https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0022399909002657
Managing complex patients on a medical psychiatric unit: An observational study of university hospital costs associated with medical service use, length of stay, and psychiatric intervention. C. Leue, G. Driessen, et al. Journal of Psychosomatic Research. Mar 2010.
— https://doi.org/10.1016/j.jpsychores.2009.04.010
Integrating Medical and Psychiatric Treatment in an Inpatient Medical Setting. A. Stoudemire. Psychosomatics. July-Aug 2000.
— https://doi.org/10.1176/appi.psy.41.4.366
How to Join
If you are interested in more information about the MPU Consortium or to be added to the email list serve please send an email to: MedPsychUnit@URMC.Rochester.edu
Join us at the 2022 Annual AMP meeting!