ALAN STOUDEMIRE, M.D. BARRY S. FOGEL, M.D. Organization and development of combined medical-psychiatric units: Part 1 Dr. Stoudemire is assistant professor of psychiatry, Emory University School ofMedicine , and Dr. Fogel is assistant professor of psychiatry, Brown University School of Medicine. Reprint request to Dr. Stoudemire, Section of Psychiatry, Emory University Clinic, J 365 Clifton Road, N.E., Atlanta, GA 30322. ABSTRACT: Key issues examined in this first of a two-part series on the organization and development of combined medical-psychiatric units include definition of the intended patient populations, features of the physical environment for both patients and staff, diagnostic and therapeutic capabilities, kinds of psychiatric therapy in relation to this particular therapeutic milieu, and the roles of other mental health practitioners. This evaluation, along with the subsequent discussion of associated features in Part 2, is intended to provide a comprehensive guide for assessing the feasibility of successfully operating a combined unit within a general hospital setting. In the past five years, interest has in- creased in the development of special- ized inpatient settings for combined psychiatric and medical treatment. While several program descriptions'·- and one comparative study· have been published, comprehensive guidelines for the development of medical-psy- chiatric units (MPUs) have not yet ap- peared in the literature. This two-part article provides a systematic approach to organizing and operating these units, based on the authors' exper- ience in developing and managing them in different settings, and in con- sulting to hospitals considering form- ing combined inpatient programs. Issues addressed in Part I ofthis se- ries will include selection and admis- sion of patients, architectural and physical environment, medical and diagnostic therapeutic resources re- quired, psychiatric therapy and the therapeutic milieu, and roles of other mental health disciplines on the unit. The term "medical-psychiatric unit" has been applied to a number of different entities. In this paper, we will discuss units that are oriented to- ward the admission and treatment of patients with combined medical and psychiatric illness, that attempt to in- tegrate medical and psychiatric care, and that emphasize a disease model of psychopathology. Units so defined may take a variety of forms, depend- ing on their administrative environ- ment, the nature of the local medical and psychiatric communities, and the orientation of their leadership. Be- cause of this heterogeneity, and be- cause descriptions and empirical stud- ies of MPUs are few, our guidelines can be regarded only as an informed view, rather than as final conclusions based on adequate data. Nonetheless, we believe that the guidelines mayof- fer a valuable starting point for those considering an MPU, and constitute a framework for debate and further study. Selection and admission of patients By definition, MPUs maintain their distinctive patient population by pro- moting the admission of patients with MAY 1986- Y0L27- N05 341