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Re-Thinking Acute Psychiatric Inpatient Care

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  • Kingsley Norton

    (Henderson Hospital, UK, knorton@sghms.ac.uk)

Abstract

Background : Reports of low staff morale and high levels of patient complaints suggest that acute psychiatric wards are not achieving their full therapeutic potential. Aims : 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. Method : 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.

Suggested Citation

  • Kingsley Norton, 2004. "Re-Thinking Acute Psychiatric Inpatient Care," International Journal of Social Psychiatry, , vol. 50(3), pages 274-284, September.
    • Handle: RePEc:sae:socpsy:v:50:y:2004:i:3:p:274-284
    DOI: 10.1177/0020764004043146
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    References listed on IDEAS

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    Cited by:

    1. Christoph Lauber & Carlos Nordt & Helene Haker & Luis Falcato & Wulf Rössler, 2006. "Community Psychiatry: Results of a Public Opinion Survey," International Journal of Social Psychiatry, , vol. 52(3), pages 234-242, May.
    2. Justine Schneider & Chris Beeley & Kezia Scales & Simon Bailey & Mieke Verhaeghe & Piet Bracke, 2013. "Ward features and stigma experiences of mental health service users in Belgium and England: A replication study," International Journal of Social Psychiatry, , vol. 59(6), pages 602-608, September.
    3. Peter Tyrer & Geetha Suryanarayan & Bharti Rao & Domenic Cicchetti & Naomi Fulop & Fiona Roberts & Jeremy Slaughter, 2006. "The Bed Requirement Inventory: A Simple Measure To Estimate The Need For A Psychiatric Bed," International Journal of Social Psychiatry, , vol. 52(3), pages 267-277, May.

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