What do we know about life on acute psychiatric wards in the UK? a review of the research evidence

Service attachment: The relative contributions of ward climate perceptions and attachment anxiety and avoidance in male inpatients with psychosis

“…This led to a growth in research which still remains relevant, particularly since expenditure on inpatient care accounts for 65% of UK health authorities' overall mental health budget (Health Select Committee, 1998;cited in Quirk & Lelliot, 2001). Furthermore, with an ever increasing emphasis currently being placed on care in the community (Quirk & Lelliot, 2001), it is becoming apparent that "acute psychiatric wards are not achieving their full therapeutic potential" (Norton, 2004, p. 274).…”

“…These individuals tend to be young males with a diagnosis of schizophrenia (Davies, 2004;Davison, 2004;Lelliot, 1996). In recent years, various government initiatives With increasing emphasis being placed on care in the community (Quirk & Lelliot, 2001), and increasingly pressured acute wards, it is felt that inpatient settings are being neglected (Ford, Durcan, Warner, Hardy & Muijen, 1998). The Department of Health (2002) The definition of relational security has been further developed by Kennedy (2002) who talks about the quantitative aspects of relational security (i.e.…”

“…The intangibility o f relational security, particularly the more qualitative aspects, combined with the dearth of research that has been conducted into exploring how the changing institutional context of inpatient care is affecting inpatients and their experience of the service (Quirk & Lelliot, 2001), may explain the deficiencies in provision o f suitable levels of relational security within services. Given that relational security is concerned with developing good interpersonal relationships between staff and patients (Dale & Gardner, 2001), it is important to assess the importance of this, particularly in relation to individuals who have already experienced fragmented relationships in the past and for whom detention can be a very stressful experience.…”

Psychiatric Units in general hospitals. Problems and perspectives in Europe

“…Perhaps the most important reason is that hospital care, in the often idealized context of community care, has come to represent what Lelliott -who has produced some of the most stimulating contributions in the area of acute inpatient care (Quirk & Lelliott, 2001;Lelliott & Quirk, 2004;Quirk et al, in press) -has called a 'default option': an option to be used when everything else has failed, or when nobody knows what to do. But this position is anachronistic: indeed "There is no evidence that a balanced system of mental health care can be provided without acute beds" (Thornicroft & Tansella, 2004).…”

“…Quali sono le ragioni di questa omissione? Forse la ragione essenziale di cio risiede nel fatto che l'assistenza ospedaliera, nel contesto talvolta idealizzato dell'assistenza di comunita, ha finito per rappresentare una sorta di "default option', come la defmisce acutamente in uno degli editoriali che seguono Paul Lelliott, che in Gran Bretagna ha promosso alcune delle piu interessanti e sofisticate ricerche sul mondo dei reparti psichiatrici ospedalieri (Quirk & Lelliott, 2001;Lelliott & Quirk, 2004;Quirk et al, in press); una opzione, cioe, di riserva, da attivare quando tutte le altre sono fallite o quando non si sa piu cosa fare. Ma una posizione del genere appare oggi a dir poco anacronistica: infatti, "non vi e alcuna evidenza che un equilibrato sistema di assistenza nel campo della salute mentale pud essere fornito senza letti per acuti" (Thornicroft & Tansella, 2004).…”