Treatment characteristics of psychiatric programs that correlate with patient community adjustment

Abstract

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.

Acute in-patient psychiatry: how patients spend their time on acute psychiatric wards

“…There is some evidence that wards with more social interaction are associated with better clinical outcome (Collins et al, 1985). However, owing to staff ratios of typically one nurse to four or five patients and the numerous other demands on nurses' time, one-toone interactions with staff form a small part of each patient's day.…”

“…Arguably it is the quality of relationships that matters to patients, and a small number of highly significant interactions may be more important than the amount of time spent interacting. However, wards with more active patients seem to be associated with better therapeutic outcome (Collins et al, 1985) and numerous reports, including that from the Department of Health (2002), cite the advantages of organised activities and the deleterious impact of inactivity.…”

Social Climate within an Adolescent Medium-Secure Facility

“…Previous research has suggested that social climate may be a potential contributor to treatment outcome (Collins et al, 1985;Ellsworth, 1983;Gunderson, 1983;Hansen & Slevin, 1996;Melle et al, 1996). However, one study failed to find such a link and suggested that a therapeutic social climate was associated with a longer length of hospital stay (Lehman et al, 1982).…”

Inpatient care 50 years after the process of deinstitutionalisation

“…Although much has changed in the nature of inpatient provision with the move away from the hospital asylum, the essential association between social interaction and better clinical outcome continued to be reported across the next two decades [3] as has the low level of patient and staff interaction [4]. It seems likely that although no recent study has examined the issue, these associations remain.…”