In-patient and residential alternatives to standard acute psychiatric wards in England

Gilburt, Helen; Lloyd‐Evans, Brynmor; Osborn, David; Boardman, Jed; Leese, Morven; Shepherd, Geoff; Thornicroft, Graham; Slade, Mike

doi:10.1192/bjp.bp.108.051698

Cited by 61 publications

(86 citation statements)

References 20 publications

(19 reference statements)

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“…Poor relationships between staff and service users are frequently reported [6], [7], [8]. Inpatient ward staff identify several barriers to developing therapeutic relationships including: low staffing levels; an associated lack of staff continuity; bureaucratic demands; and uncertainty about the adoption and implementation of therapeutic models [9]. Unsurprisingly, reforming acute care was recently identified as the highest priority of mental health staff and service users in England [10].…”

Section: Introductionmentioning

confidence: 99%

“…Crisis houses tend to be smaller than their hospital counterparts, with a more domestic atmosphere [9], [11]. They are generally well-embedded in the local healthcare system, serving similar populations to inpatient wards, although they rarely admit people compulsorily and fewer people have a history of violence [9], [11]. Force, restraint and seclusion are rarely used.…”

Section: Introductionmentioning

confidence: 99%

“…Several of the authors were involved in a precursor to this study, the Alternatives Study, which employed mixed research methods to investigate and compare inpatient crisis care with residential alternatives [9], [11], [14]–[19]. Service user populations were in many respects found to be similar in hospitals and in crisis houses, for example with no significant differences in employment rates, previous history of psychiatric hospital admission and recent history of self harm (11).…”

Section: Introductionmentioning

confidence: 99%

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The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Sweeney¹,

Fahmy²,

Nolan

et al. 2014

PLoS ONE

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BackgroundPoor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses.Methods and FindingsMixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically.ResultsWe found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy.Conclusions and ImplicationsWe found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Sweeney¹,

Fahmy²,

Nolan

et al. 2014

PLoS ONE

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“…Studies of recovery-oriented staff training in community-based settings have shown positive changes in staff attitudes (9). Evaluations of the recovery-orientation of mental health services have focused on outpatient and rehabilitative facilities rather than inpatient facilities (10,11). Moreover, the recovery-orientation among staff in psychiatric hospitals appears to be lower than that in community settings (12,13).…”

Section: Introductionmentioning

confidence: 99%

Patients’ subjective perspective on recovery orientation on an acute psychiatric unit

Jaeger¹,

Konrad

Rueegg

et al. 2014

Nordic Journal of Psychiatry

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Background : Evaluations of the recovery orientation of mental health services have focused on outpatient and rehabilitative rather than acute inpatient facilities. Aim : This naturalistic observational study seeks to evaluate the subjective perspective and functional outcome of inpatients before and after structural alterations. The changes made were the introduction of treatment conferences and conjoint treatment planning, reduction of the total time spent on reports about patients (in their absence), and recovery-oriented staff training on an acute psychiatric unit of the University Hospital of Psychiatry, Zurich, Switzerland. Methods : During 1 year (2011/2012) eligible patients on the study unit were interviewed on a voluntary basis using established instruments to assess several recovery-relevant aspects. Two different samples (before and after the project; n 34 and n 29) were compared with regard to subjective parameters (e.g. patients ' attitudes toward recovery, quality of life, perceived coercion, treatment satisfaction, and hope), clinical and socio-demographic basic data, as well as the functional outcome according to the Health of the Nation Outcome Scales (HoNOS). Results: Some patient attitudes towards recovery and their self-assessment of the recovery process improved during the study. Other subjective parameters remained stable between samples. Functional outcome was better in subjects who were treated after the implementation of the new concept. The length of stay remained unchanged. Conclusions: The implementation of recovery-oriented structures and providing the necessary theoretical underpinning on an acute psychiatric unit is feasible and can have an impact on attitudes and knowledge of personal recovery.

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“…Fifty years of deinstitutionalization of psychiatric care have produced creative alternatives to the inpatient ward as the locus of treatment [1,2]. Options available to the acutely ill include expanded community mental health care facilities and mobile treatment teams such as assertive community treatment (ACT) [3].…”

Section: Introductionmentioning

confidence: 99%

The Residential Care Alternative for the Acutely Psychotic Patient

Lichtenberg

2011

Psychiatr Q

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Community homes for the treatment of the acutely psychiatrically ill have been established in several places in the world as alternatives to inpatient hospitalizations. We reviewed sources from the psychiatric and psychological literature which examine these models. Several features are common to this treatment setting: fewer residents in comparison with hospital wards; a supportive and caring milieu including intense and regular therapeutic contact with staff; a de-emphasis of medication; and a destigmatization of the therapeutic treatment of psychosis. The models differ with respect to use of psychotropic medication, emphasis upon first admissions, and composition of staff. The varying models are comparable to inpatient treatment in terms of clinical and psychosocial outcome, and generally cost less. For most patients requiring psychiatric hospitalization, residential treatment can be a viable alternative to inpatient hospitalization. Issues of cost, therapeutic effectiveness, and long-term outcomes still need to be studied.

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In-patient and residential alternatives to standard acute psychiatric wards in England

Cited by 61 publications

References 20 publications

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Patients’ subjective perspective on recovery orientation on an acute psychiatric unit

The Residential Care Alternative for the Acutely Psychotic Patient

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