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Bus Therapy A Problematic Practice in Psychiatry

Smita Das, MD, PhD, MPH1; Sebastien C. Fromont, MD2; Judith J. Prochaska, PhD, MPH3
[+] Author Affiliations
1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
2Department of Psychiatry, University of California, San Francisco School of Medicine
3Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
JAMA Psychiatry. 2013;70(11):1127-1128. doi:10.1001/jamapsychiatry.2013.2824.
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Crossing state lines, a man arrives alone in San Francisco, having traveled by bus on a 1-way ticket provided by a psychiatric hospital in his home state. He is disoriented, with few possessions, lacks medications and medical records, and calls 911 as he was instructed. He is brought to the county psychiatric emergency service, which, hectic and often over capacity, treats nearly 6000 patients annually (of which 39% are not San Francisco residents). The patient needs housing, a psychiatrist, case manager, primary care provider, and transfer of Medicaid or general assistance—a package known colloquially as the San Francisco Special. Placements are challenging—the county hospital reduced its acute inpatient psychiatry capacity 50% in the last 5 years owing to budget shortfalls—yet out-of-state visitors are not turned away.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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