title: Inpatient care 50 years after the process of deinstitutionalisation.
abstract: OBJECTIVE
  Throughout the past 50 years mental health services have aimed to provide and improve high quality inpatient care. It is not clear whether there has been improvement as service users and nursing staff have both expressed frustration at the lack of therapeutic activities. In particular, it may be that the changing levels of symptoms over the past 50 years may affect engagement with ward activities.
  
  
  METHODS
  Eight wards in a health care trust in London serving an inner city and urban populations participated. Data were collected on participation in activities and 116 service users' perceptions of acute care as well as clinical factors.
  
  
  RESULTS
  Less time was spent participating in activities today than 50 years ago, while one quarter of service users reported taking part in no activities at all. Uptake of activities was related to more positive service user perceptions of the wards. Symptom severity did not impact the frequency of participation in activities, although those who took part in no activities at all had higher negative symptoms scores.
  
  
  CONCLUSIONS
  Service users' uptake of activities was not related to the severity of their illness. This belies the belief that the acutely ill cannot take part in meaningful activities. This study supports the view that more therapeutic activities could be taken up by the acutely ill and are in fact appreciated.
authors.affiliation: Department of Psychology, Institute of Psychiatry, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK, emese.1.csipke@kcl.ac.uk.
authors.forename: Emese
authors.initials: E
authors.lastname: Csipke
authors.forename: Clare
authors.initials: C
authors.lastname: Flach
authors.forename: Paul
authors.initials: P
authors.lastname: McCrone
authors.forename: Diana
authors.initials: D
authors.lastname: Rose
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Tilley
authors.forename: Til
authors.initials: T
authors.lastname: Wykes
authors.forename: Tom
authors.initials: T
authors.lastname: Craig
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003688:Deinstitutionalization; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D008131:London; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D011204:Poverty Areas; D012017:Referral and Consultation; D014505:Urban Population