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Characteristics of efficient (high turnover) and effective (low return rate) psychiatric units were examined. Nursing staff and patients tended to attribute negative characteristics to efficient units. Effective programs, on the other hand, were characterized as having motivated professional staff and active participant roles for both nursing staff and patients.

This large Veterans Administration cooperative study sought to identify the ward milieu characteristics of effective psychiatric programs. It was developed as a multivariable, correlational study that involved systematic observations of program characteristics and outcome effectiveness of wards as they operated in their usual manner. Seventy‐nine wards in 18 hospitals provided 11,283 patients eligible for follow‐up. Eleven treatment characteristics were found to be correlated to patients' community adjustment 3 months after discharge. These characteristics were classified into five general categories: Patient‐staff interaction, patient activities, medication practices, ward physical environment, and nursing staff rotation. The major conclusions are: (1) wards do differ in their effectiveness as measured by ratings of patient posthospital adjustment; and (2) treatment characteristics make a difference in program effectiveness as measured by patients' posthospital adjustment.

The concept of mental illness as a disease process has resulted in the focusing of psychiatric attention on the symptoms which a "mentally ill" patient manifests. The extent to which a mentally ill person improves is traditionally based on the extent to which the original symptom picture becomes modified. As with most disease entities, the patient is judged as having recovered when the symptoms of the disease abate.Descriptive psychiatry, as practiced in most mental hospitals today, is based on the diagnostic classifications outlined by Kraepelin. His observation that the praecox progressed to a demented end-state led him to believe that this process was based on some degenerative "disease" process. Later evidence discredits the idea of the necessary demented end product, and, to a lesser extent, that this disease occurs only in young adults. The original evidence, then, for regarding dementia praecox as a disease process is no longer consistent with observations following those of Kraepelin. The hypothesis may still be true, but the evidence upon which the hypothesis was based is no longer accepted.The agreement of the American Psychiatric Association on a classification system in 1934 was a major step forward. Professional personnel had at last come to agree on a common system which facilitated communication and research. It is unfortunate, however, that many psychiatrists still regard the classifications as synonymous to disease entities, although the majority of the psychiatric group 1 In cooperation with Psychiatric and Nursing Services, particularly Anna Kontas, who supervised the collection of all admission behavioral data. This study was supported by the Psychiatric Evaluation Project, Richard L. Jenkins, Director.

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