Re-thinking acute psychiatric inpatient care.
BACKGROUND
Reports of low staff morale and high levels of patient complaints suggest that acute psychiatric wards are not achieving their full therapeutic potential.


OBJECTIVE
This paper reviews some of the 'therapeutic milieu' literature to identify ways of construing ward functioning so as to maximise therapeutic and minimise destructive processes within inpatient units.


METHODS
Relevant papers are reviewed, providing an understanding that permits the inpatient clinician to consider and apply the pertinent concepts.


RESULTS
Five key therapeutic functions of the ward environment are identified containment, support, structure, involvement and validation. Four destructive processes are described, relating to: the isolated patient; group phenomena; the contribution of staff; and structural manifestations in the ward.


CONCLUSIONS
The inpatient ward can be construed as a 'whole', embodying a range of therapeutic functions, which may need rapid deployment and dismantling, as dictated by changes in ward conditions. The 'ward-as-a-whole' construct complements individualised models of patient care and the practical implications of such thinking could engender a greater sense of agency and job satisfaction in staff.
Norton
Kingsley
K
Henderson Hospital, Surrey, UK. knorton@sghms.ac.uk
D000208:Acute Disease; D006126:Group Processes; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D001523:Mental Disorders / Q000534:rehabilitation*; D012931:Social Environment