Residential alternatives to acute in-patient care in England: satisfaction, ward atmosphere and service user experiences

BackgroundAlternatives to traditional in-patient services may be associated with a better experience of admission.AimsTo compare patient satisfaction, ward atmosphere and perceived coercion in the two types of service, using validated measures.MethodThe experience of 314 patients in four residential alternatives and four standard services were compared using the Client Satisfaction Questionnaire (CSQ), the Service Satisfaction Scale – Residential form (SSS–Res), the Ward Atmosphere Scale (WAS) and the Admission Experience Scale (AES).ResultsCompared with standard wards, service users from alternative services reported greater levels of satisfaction (mean difference CSQ 3.3, 95% CI 1.8 to 4.9; SSS–Res 11.4, 95% CI 5.0 to 17.7). On the AES, service users in alternatives perceived less coercion (mean difference –1.3, 95% CI –1.8 to –0.8) and having more ‘voice’ (mean difference 0.9, 95% CI 0.6 to 1.2). Greater autonomy, more support and less anger and aggression were revealed by WAS scores. Differences in CSQ and AES scores remained significant after multivariable adjustment, but SSS–Res results were attenuated, mainly by detention status.ConclusionsCommunity alternatives were associated with greater service user satisfaction and less negative experiences. Some but not all of these differences were explained by differences in the two populations, particularly in involuntary admission.

Effects of Consultation on the Ward Atmosphere in a State Psychiatric Hospital

The Ward Atmosphere Scale was used to assess the development of a therapeutic milieu in a clinical ward converted to a research unit at a state psychiatric hospital. The designated ward had been considered a “problem ward” with low staff moral, a high incidence of violence by patients, and high incidence of injuries to patients and staff. The scale was administered to patients and staff on two occasions. The results of the first administration were presented to staff, and from these consultation sessions, a therapeutic milieu developed. The scale was readministered 3 mo. after the implementation of the therapeutic milieu. Significant improvements were seen in staff's perception of the ward environment, incidence of patients' assaults, and staff use of seclusion and restraints.