"Revolving Door" Syndrome

There is a vicious cycle that sometimes links workplace violence, psychiatric treatment, and the "revolving door":

• Stage 1: The intensive psychiatric hospital treatment for some mentally ill patients may be cut short because of insurance pressures for early discharge;
• Stage 2: Community-based follow-up treatment and medication monitoring are inadequately staffed and supervised;
• Stage 3: Patient enters general hospital Emergency Department when in crisis;
• Stage 4: De-escalation and/or chemical restraint is applied;
• Stage 5: Patient is discharged with minimal or no psychiatric follow-up;
• Stage 6: Patient experiences a repeat crisis episode and admission to ED—and the "revolving door" continues.

The rate of recidivism (return for treatment) is extremely high and these patients may be referred to as "frequent fliers." Some end up in the criminal justice system where psychiatric treatment is minimal or non-existent.