title: Residential alternatives to acute in-patient care in England: satisfaction, ward atmosphere and service user experiences.
abstract: BACKGROUND
  Alternatives to traditional in-patient services may be associated with a better experience of admission.
  
  
  OBJECTIVE
  To compare patient satisfaction, ward atmosphere and perceived coercion in the two types of service, using validated measures.
  
  
  METHODS
  The experience of 314 patients in four residential alternatives and four standard services were compared using the Client Satisfaction Questionnaire (CSQ), the Service Satisfaction Scale - Residential form (SSS-Res), the Ward Atmosphere Scale (WAS) and the Admission Experience Scale (AES).
  
  
  RESULTS
  Compared with standard wards, service users from alternative services reported greater levels of satisfaction (mean difference CSQ 3.3, 95% CI 1.8 to 4.9; SSS-Res 11.4, 95% CI 5.0 to 17.7). On the AES, service users in alternatives perceived less coercion (mean difference -1.3, 95% CI -1.8 to -0.8) and having more ;voice' (mean difference 0.9, 95% CI 0.6 to 1.2). Greater autonomy, more support and less anger and aggression were revealed by WAS scores. Differences in CSQ and AES scores remained significant after multivariable adjustment, but SSS-Res results were attenuated, mainly by detention status.
  
  
  CONCLUSIONS
  Community alternatives were associated with greater service user satisfaction and less negative experiences. Some but not all of these differences were explained by differences in the two populations, particularly in involuntary admission.
authors.affiliation: Department of Mental Health Sciences, University College London, Rowland Hill Street, London NW3 2PF, UK. d.osborn@medsch.ucl.ac.uk.
authors.forename: David P J
authors.initials: DP
authors.lastname: Osborn
authors.forename: Brynmor
authors.initials: B
authors.lastname: Lloyd-Evans
authors.forename: Sonia
authors.initials: S
authors.lastname: Johnson
authors.forename: Helen
authors.initials: H
authors.lastname: Gilburt
authors.forename: Sarah
authors.initials: S
authors.lastname: Byford
authors.forename: Morven
authors.initials: M
authors.lastname: Leese
authors.forename: Mike
authors.initials: M
authors.lastname: Slade
mesh_terms: D000208:Acute Disease; D000328:Adult; D000374:Aggression / Q000523:psychology; D000786:Anger; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data; D003155:Community Mental Health Centers; D004739:England; D005260:Female; D006272:Health Facility Environment; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D015999:Multivariate Analysis; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D026684:Personal Autonomy; D011369:Professional-Patient Relations; D012044:Regression Analysis; D011795:Surveys and Questionnaires