Community Series - Redefining Acute Psychiatric Care: Strategies for Managing Complex Comorbidities in Inpatient and Day Hospital Settings

This Research Topic is the third volume in our Community Series. Our first volume can be read here and our second collection here.Evidence-based practice suggests minimizing the length of hospital stay for patients with mental health disorders by using hospitalization — inpatient or day hospital — as the starting point of a new, individualized therapy project. Territorial multidisciplinary teams with a designated case manager are particularly effective in reducing relapses in severe mental disorders, and intensive case management reduces hospitalizations while improving continuity of the service relationship. Even where the therapeutic project is organized outside the hospital, there remains a need to improve acute-phase care itself — both its appropriateness and its quality — including in day hospital settings, which offer an intermediate level of intensity for patients who do not require full admission but need structured, close support.This need becomes more pressing when patients present with complex comorbidities: co-occurring medical conditions, substance use disorders, personality disorders, or multiple concurrent psychiatric diagnoses. These patients often cross the boundaries between inpatient and day hospital care, and their management requires coordinated protocols, staff trained across disciplines, and treatment pathways flexible enough to follow the patient between settings rather than resetting at each transition.Although length of stay should be limited, the hospital and day hospital must both be places where the patient feels supported, receives personalized care, and gets an answer to their needs. Central to this is reducing mandatory health treatments and mechanical/pharmacological restraints — a goal made harder, not easier, by comorbidity, and one that calls for setting-specific strategies. Acute care, whether inpatient or day hospital, should be a phase of the patient’s broader care project, not an isolated intervention. Evidence-based psychosocial rehabilitation practices — patient and family psychoeducation, for instance — should begin as early as possible, adapted to each setting, to improve engagement and long-term outcomes.Certain at-risk populations warrant particular attention across both settings: adolescents, elderly patients, and those with substance use disorders or medical comorbidities — groups for whom the choice between inpatient and day hospital care, and the management of coexisting conditions, is especially consequential. Staff training remains essential: teamwork methods, prevention and management of hetero-aggressive and suicidal risk, interview techniques, and building a sound therapeutic relationship — now extended to the specific challenges that comorbidity and cross-setting care introduce.This Research Topic aims to evaluate outcomes of acute psychiatric care — in both inpatient and day hospital settings — for patients with complex comorbidities, across diagnoses and patient types. We are interested not only in clinical outcomes (improvement in the psychopathological symptoms prompting admission) but also in psychosocial functioning, and in how comorbidity and care setting interact to shape both.We welcome articles on, but not limited to, the following themes:- Management of psychiatric patients with complex medical, substance use, or personality comorbidities in inpatient and day hospital settings- Comparative outcomes and care pathways between inpatient and day hospital models for comorbid patients- Personal recovery of patients with comorbidities during and after acute care- Patients’ legal rights across inpatient and day hospital settings- Ethical issues in treating patients with comorbid mental health and other conditions- The psychiatrist’s and multidisciplinary team’s role in supporting patients with comorbidities toward a fulfilling life- Treatments and therapies for inpatients and day hospital patients with complex comorbidities- Transition and continuity-of-care strategies between inpatient, day hospital, and community settings- Risk management (aggression, suicidality) in comorbid populations across acute care settings Topic editors: Stefano Barlati, Alfonso Ceccherini-Nelli Source: https://www.frontiersin.org/research-topics/85327/community-series---redefining-acute-psychiatric-care-strategies-for-managing-complex-comorbidities-in-inpatient-and-day-hospital-settings