title: The treatment of 'difficult' patients in a secure unit of a specialized psychiatric hospital: the patient's perspective.
abstract: The aim of this study is to obtain insight, from a patient's perspective, into the results and essential components of treatment in specialist settings for so-called 'difficult' patients in mental health care. In cases where usual hospital treatment is not successful, a temporary transfer to another, specialist hospital may provide a solution. We investigated which aspects of specialist treatment available to 'difficult' patients are perceived as essential by the patients and what are the results of this treatment in their perception. A qualitative research design based on the Grounded Theory method was used. To generate data, 14 semi-structured interviews were held with 12 patients who were admitted to a specialist hospital in the Netherlands. Almost all respondents rated the results of the specialist treatment as positive. The therapeutic climate was perceived as extremely strict, with a strong focus on structure, cooperation and safety. This approach had a stabilizing effect on the patients, even at times when they were not motivated. Most patients developed a motivation for change, marked by a growing and more explicit determination of their future goals. We concluded that a highly structured treatment environment aimed at patient stabilization is helpful to most 'difficult' patients.
authors: Department of Nursing, Utrecht University of Applied Sciences, Utrecht, The Netherlands. mathildebos@planet.nl
authors: M
authors: M
authors: Bos
authors: N
authors: N
authors: Kool-Goudzwaard
authors: C J
authors: CJ
authors: Gamel
authors: B
authors: B
authors: Koekkoek
authors: B
authors: B
authors: van Meijel
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression / Q000523:psychology; D005260:Female; D006778:Hospitals, Psychiatric / Q000458:organization & administration; D006782:Hospitals, Special / Q000379:methods / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D061214:Patient Safety; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D012649:Self Concept; D055815:Young Adult