Purpose of review
No country has created a mental health care system that can function without ‘acute’ psychiatric wards for the admission of people who require short-term hospital care to treat their mental disorder and prevent them causing harm to themselves or others. Previous research indicates that the quality of care on acute wards is under threat, especially in countries that have undergone a process of ‘deinstitutionalization’. This review describes what life is like on such wards by presenting research findings primarily from qualitative studies.
Despite great diversity in the structure of mental health services internationally, certain themes or problems appear to be common to all acute wards. First, ward staff are preoccupied with the management of dangerous behaviours and patient throughput. Second, a complex set of factors influence how staff respond to dangerous behaviours: these relate to the patient, the nature of the problem behaviour, staff attitudes and organizational context. Third, ward nurses are dissatisfied with the difficulty they have in forming therapeutic relationships in this particular setting and patients dislike the centrality of pharmacological interventions at the expense of psychological approaches.
This review suggests a need to rethink the purpose and function of acute psychiatric wards. Research is required to investigate (1) which interventions improve the safety, and the perception of safety, of the wards, and (2) what strategies improve the quality of therapeutic relationships between staff and patients.