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Rodríguez-Labajos L, Kinloch J, Grant S, O’Brien G. The Role of the Built Environment as a Therapeutic Intervention in Mental Health Facilities: A Systematic Literature Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:281-308. [PMID: 38385552 PMCID: PMC11080396 DOI: 10.1177/19375867231219031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES This systematic literature review synthesizes and assesses empirical research concerning the use of the built environment as a therapeutic intervention in adult mental health inpatient facilities. The review explores the impact of facility design on patient outcomes. BACKGROUND There is a growing recognition that the built environment in mental health facilities must strike a balance between ensuring safety and providing a therapeutic atmosphere. A review addressing how facility design contributes to this therapeutic environment is warranted. METHODS Database searches were conducted in CINAHL, Embase, PsychInfo, PubMed, and Web of Science from inception up to March 10, 2022. The Scottish Intercollegiate Guidelines Network (SIGN50) critical appraisal checklists were used to assess the quality of included studies. RESULTS Of the 44 peer-reviewed studies identified from nine countries, several factors emerged as vital for the therapeutic environment in mental health inpatient facilities. These included personal spaces prioritizing privacy and control of the environment, daylight-optimized spaces, versatile communal areas promoting activities and interaction, designated areas for visits and spiritual/contemplative reflection, homelike environments, the inclusion of artwork in units, open nursing stations, and dedicated female-only areas. Yet, there is a need for research yielding stronger evidence-based designs harmonizing with therapeutic needs. CONCLUSION This review offers initial guidance on designing mental health facilities that foster a therapeutic environment, while highlighting that the influence of facility design on mental health inpatients is considerably under-researched.
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Affiliation(s)
| | - Joanne Kinloch
- Research Service, NHSScotland Assure, NHS National Services Scotland, Glasgow, Scotland
| | - Susan Grant
- Procurement, Commissioning and Facilities, NHSScotland Assure, NHS National Services Scotland, Glasgow, Scotland
| | - Geraldine O’Brien
- Research Service, NHSScotland Assure, NHS National Services Scotland, Glasgow, Scotland
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Rodwell D, Frith H. Using a trauma-informed care framework to explore social climate and borderline personality disorder in forensic inpatient settings. Int J Ment Health Nurs 2024. [PMID: 38291657 DOI: 10.1111/inm.13300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
Tensions between therapeutic and security needs on forensic wards can create a social climate which is challenging for both mental health nurses and patients. Social climate refers to the physical, social and emotional conditions of a forensic ward which influence how these environments are experienced. For patients with borderline personality disorder (BPD), previous trauma means that the social climate of forensic settings may be experienced as retraumatising, negatively impacting the outcomes and wellbeing of both patients and mental health nurses. Trauma-informed care (TIC) has been offered as a contemporary framework for mental health nursing in inpatient units which aims to create a therapeutic social climate. In this critical review, we drew widely on literatures examining the social climate in forensic settings, the relationships between patients with BPD and staff (including mental health nurses), and the experiences of patients with BPD in forensic and inpatient settings to draw out the implications of scrutinising these literatures through the lens of TIC. Attending to the physical, social and emotional conditions of social climate in secure settings highlights how forensic wards can mirror trauma experiences for patients with BPD. Implementing TIC in these contexts has the potential to evoke positive shifts in the social climate, thus reducing the risk of retraumatisation and leading to improved outcomes for patients and staff.
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Affiliation(s)
- Devon Rodwell
- School of Psychology, University of Surrey, Guildford, UK
| | - Hannah Frith
- School of Psychology, University of Surrey, Guildford, UK
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3
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Britt-Thomas JY, Kridel M, Velez J, Kouame G, Tharrington S, Barrett T, Casanova T. A scoping review of institutional policies and recommendations for trans inpatient mental health care. J Psychiatr Ment Health Nurs 2023; 30:1043-1053. [PMID: 37202857 DOI: 10.1111/jpm.12933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/30/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: International guidelines for trans-and-gender-non-conforming (TGNC) exists in outpatient settings. Compared to cisgender and heterosexual people, TGNC individuals are at a higher risk of mental health difficulties and have higher rates of inpatient mental health treatment. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: An international scoping review identifying the lack of guidelines existing for TGNC individuals in inpatient mental health settings. Compared to psychiatrists and psychologists, mental health nursing has the most contact with patients admitted for inpatient psychiatric treatment. The study identifies unaddressed needs in gender affirming policies and outlines preliminary policy recommendations to assist mental health staff in improving TGNC patient quality of care within the United States. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Reforming existing guidelines or creating new guidelines based on the identified themes and gaps to improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings within the United States. ABSTRACT INTRODUCTION: Access to culturally sensitive care is critical for addressing known mental health disparities among trans-and gender-non-conforming (TGNC) individuals. Although there has been a proliferation of TGNC healthcare guidelines from accrediting bodies, policies have failed to address the needs of TGNC patients in inpatient psychiatric settings. AIM To identify unaddressed needs in policies and policy recommendations for the care of TGNC patients to inform recommendations for change. METHOD A scoping review protocol was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 850 articles were reduced to seven relevant articles with six themes identified via thematic analysis. RESULTS Six themes were identified: lack of consistency in preferred and pronoun use, lack of communication among providers, lack of training in TGNC healthcare, personal bias, lack of formal policies, and housing segregation by sex rather than gender. DISCUSSION The creation of new guidelines or bolstering of existing guidelines to specifically address identified themes and gaps may improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings. IMPLICATIONS FOR PRACTICE To provide a foundation for future studies to integrate these identified gaps and inform the future development of comprehensive formal policies that generalize TGNC care in inpatient settings.
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Affiliation(s)
- Jessica Y Britt-Thomas
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Matthew Kridel
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Janina Velez
- Clinical Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Gail Kouame
- Charles M. Baugh Biomedical Library, University of South Alabama, Mobile, Alabama, USA
| | - Shafer Tharrington
- Robert B. Greenblatt, M.D. Library, Augusta University, Augusta, Georgia, USA
| | - Thomas Barrett
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Tracy Casanova
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Guo H, Zhou W, Lai W, Yao L. What landscape elements are needed for hospital healing spaces? Evidence from an empirical study of 10 compact hospitals. Front Public Health 2023; 11:1243582. [PMID: 38074756 PMCID: PMC10706125 DOI: 10.3389/fpubh.2023.1243582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Background Modern medical research shows that a rationally planned landscape environment helps patients recover. With the growing number of hospital patients and the tightening of per capita medical landscape land, the use of limited landscape resources to serve patients has become challenging. Methods This study focused on the landscape environment of 10 hospitals in Guangdong Province, China. Based on the KANO theoretical model, a survey questionnaire was designed and administered to 410 participants. The data were analyzed based on demand attributes, importance, sensitivity, and group differences. Results The maintenance requirements were the most important item in the sensitivity ranking. Furthermore, the analysis revealed that the users need a safe, quiet, and private environment, owing to their higher requirements, including visual healing, rehabilitation activities, shading and heat preservation, and medical escort. Moreover, adolescents and older adult patients have common and contradictory environmental needs. For example, the landscape environment should provide both an active space and a quiet rehabilitation environment. Conclusion This study evaluates how landscape resources can be better utilized from the perspective of the user and expands the theory of healing landscapes, which has practical implications for hospital renovation and landscape environment strategies.
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Affiliation(s)
- Haoxu Guo
- School of Architecture, South China University of Technology, Guangzhou, China
- State Key Laboratory of Subtropical Building Science, South China University of Technology, Guangzhou, China
| | - Weiqiang Zhou
- School of Architecture, South China University of Technology, Guangzhou, China
- State Key Laboratory of Subtropical Building Science, South China University of Technology, Guangzhou, China
| | - Wenbo Lai
- School of Architecture, South China University of Technology, Guangzhou, China
| | - Lihao Yao
- College of Coastal Agricultural Sciences, Guangdong Ocean University, Zhanjiang, China
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Andrew L, Karthigesu S, Coall D, Sim M, Dare J, Boxall K. What makes a space safe? Consumers' perspectives on a mental health safe space. Int J Ment Health Nurs 2023; 32:1355-1364. [PMID: 37231985 DOI: 10.1111/inm.13174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
The provision of community-based space for people experiencing a mental health crisis is regarded as a favourable alternative to the emergency department. However, the only non-emergency department safe spaces in Western Australia are located within hospitals or hospital grounds. This qualitative study asked mental health consumers in Western Australia with experience of presentation at the emergency department during a mental health crisis to describe what a safe space would look and feel like. Data were collected through focus groups and thematically analysed. The findings present the voices of mental health consumers through the framework of health geography and the therapeutic landscape. These participants articulated important physical and social features of a therapeutic safe space and their symbolism as inclusive, accessible places where they would experience a sense of agency and belonging. Participants also expressed a need for trained peer support within the space to complement the skilled professional mental health team. Participants' experiences of the emergency department during mental health crises were described as contrary to their recovery needs. The research reinforces the need for an alternative to the emergency department for adults who experience mental health crises and provides consumer-led evidence to inform the design and development of a recovery-focused safe space.
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Affiliation(s)
- Lesley Andrew
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Shantha Karthigesu
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - David Coall
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Moira Sim
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Julie Dare
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kathy Boxall
- School of Arts and Humanities, Edith Cowan University, Joondalup, Western Australia, Australia
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Högström E, Philo C. 'Let there be light' or life in the dark? Vital geographies of mental healthcare. Soc Sci Med 2023; 333:116137. [PMID: 37634427 DOI: 10.1016/j.socscimed.2023.116137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
This paper explores the relations between light and dark/white and black disclosed in a study of Gartnavel Royal Hospital in Glasgow, Scotland, where an old Victorian lunatic asylum remains, if becoming ruined, on the same site as a modern mental healthcare campus. In-depth interview work recovering the 'spatial stories' of patients and staff, past and present, reveals a complex mixture of positive and negative memories and interpretations prompted by both the 'darkened spaces' of Old Gartnavel and the liveliness associated with both sets of spaces. These findings are framed by (a) a reading of Badiou's short monograph on Black (Badiou, 2017) and (b) an engagement with light and dark studies, both of which suggest a rebalancing of the normal valuations whereby dark/black is cast as the realm of death, everything that deadens and threatens life, whereas light/white is cast as that of life, liveliness and vitality. The scholarship here speaks to work on vitalist health geographies, agreeing that vital health-worlds can surface almost anywhere, but reminding that the fragility of such worlds can always be threatened by too much over-ordering.
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Affiliation(s)
- Ebba Högström
- Blekinge Institute of Technology, Spatial Planning Karlskrona, SE 371 79, Sweden.
| | - Chris Philo
- University of Glasgow, School of Geographical and Earth Sciences, Glasgow, Lanarkshire, G12 8QQ, UK.
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Valladares A, Bornstein L, Botero N, Gold I, Sayanvala F, Weinstock D. From scary places to therapeutic landscapes: Voices from the community of people living with schizophrenia. Health Place 2022; 78:102903. [PMID: 36174464 DOI: 10.1016/j.healthplace.2022.102903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022]
Abstract
This article discusses how people living with schizophrenia experience, understand, and respond to their urban environment. Our study relies on experiential photo-voice data gathered with a sample of six people diagnosed with schizophrenia and living in non-institutional settings in Montréal, Canada, to identify how individuals in this community perceive the urban landscape. We adopt a therapeutic landscapes' framework that explores the urban fabric at three levels: physical, social, and symbolic. Research participants identified both health-denying and health-enhancing places within ordinary urban landscapes. Landscapes identified as health-denying are characterized by environmental stressors and loss of control, with construction sites an example highlighted by participants. Healing and restorative landscapes, as identified by participants, were physically attractive or quiet, socially safe and welcoming, and symbolically affirmative of one's identity, all factors worthy of further study. The findings are also policy-relevant: they suggest that people living with schizophrenia and their clinicians can develop strategies to make health-enhancing uses of urban landscapes; and that urban policies and practices can foster urban environments conducive to enhanced health and well-being, both for the community of people living with schizophrenia and the wider population of urban dwellers.
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Affiliation(s)
| | | | - Nicolás Botero
- McGill University, Department of Cognitive Science, Canada
| | - Ian Gold
- McGill University, Department of Philosophy, Canada
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Beate Larsen I, Georg Friesinger J, Strømland M, Topor A. You realise you are better when you want to live, want to go out, want to see people: Recovery as assemblage. Int J Soc Psychiatry 2022; 68:1108-1115. [PMID: 34015980 PMCID: PMC9310138 DOI: 10.1177/00207640211019452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The lack of social and material perspectives in descriptions of recovery processes is almost common in recovery research. AIM Consequently, we investigated recovery stories and how people with mental health and/or addiction challenges included social and material aspects in these stories. METHOD We conducted focus group and individual interviews. We investigated how the participants narrated their stories and how they assembled places and people in their recovery stories. RESULTS We found that narratives of recovery became assemblages where humans and their environments co-exist and are interdependent. CONCLUSION As such, narratives about recovery are about everyday assemblages of well-being into which stories of insecurity are interwoven, without a start or stop point.
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Affiliation(s)
- Inger Beate Larsen
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
| | - Jan Georg Friesinger
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
- Jan Georg Friesinger, Department of Psychosocial Health, University of Agder, Jon Lilletunsvei 9, Grimstad 4879, Norway.
| | - Monica Strømland
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
| | - Alain Topor
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
- Department of Social Work, Stockholm University, Stockholm, Sweden
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Jovanović N, Miglietta E, Podlesek A, Malekzadeh A, Lasalvia A, Campbell J, Priebe S. Impact of the hospital built environment on treatment satisfaction of psychiatric in-patients. Psychol Med 2022; 52:1969-1980. [PMID: 33087185 DOI: 10.1017/s0033291720003815] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A hospital built environment can affect patients' treatment satisfaction, which is, in turn, associated with crucial clinical outcomes. However, little research has explored which elements are specifically important for psychiatric in-patients. This study aims to identify which elements of the hospital environment are associated with higher patient satisfaction with psychiatric in-patient care. METHODS The study was conducted in Italy and the United Kingdom. Data was collected through hospital visits and patient interviews. All hospitals were assessed for general characteristics, aspects specific to psychiatry (patient safety, mixed/single-sex wards, smoking on/off wards), and quality of hospital environment. Patients' treatment satisfaction was assessed using the Client Assessment of Treatment Scale (CAT). Multi-level modelling was used to explore the role of environment in predicting the CAT scores adjusted for age, gender, education, diagnosis, and formal status. RESULTS The study included 18 psychiatric hospitals (7 in Italy and 11 in the United Kingdom) and 2130 patients. Healthcare systems in these countries share key characteristics (e.g. National Health Service, care organised on a geographical basis) and differ in policy regulation and governance. Two elements were associated with higher patient treatment satisfaction: being hospitalised on a mixed-sex ward (p = 0.003) and the availability of rooms to meet family off wards (p = 0.020). CONCLUSIONS As hospitals are among the most expensive facilities to build, their design should be guided by research evidence. Two design features can potentially improve patient satisfaction: family rooms off wards and mixed-sex wards. This evidence should be considered when designing or renovating psychiatric facilities.
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Affiliation(s)
- Nikolina Jovanović
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Queen Mary University of London, UK
| | - Elisabetta Miglietta
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Anja Podlesek
- Department of Psychology, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Adam Malekzadeh
- Centre for Transport Studies (CTS), Department of Civil, Environmental & Geomatic Engineering, University College London, London, UK
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- UOC Psichiatria, Azienda Ospedaliera Universitaria Intergrata di Verona, Verona, Italy
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Queen Mary University of London, UK
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Invisible experts: a systematic review & thematic synthesis of informal carer experiences of inpatient mental health care. BMC Psychiatry 2022; 22:347. [PMID: 35596170 PMCID: PMC9121622 DOI: 10.1186/s12888-022-03872-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 03/11/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The negative impact of caregiving on carers' physical and psychological wellbeing is well documented. Carers of mental health inpatients have particularly negative experiences and largely report being dissatisfied with how they and their loved one are treated during inpatient care. It remains unclear why, despite policies intended to improve inpatient experiences. A comprehensive review of carers' inpatient experiences is needed to understand carer needs. As such, we aimed to conduct a systematic review and thematic synthesis of carer experiences of inpatient mental health care. METHODS We searched MEDLINE, PsycINFO, Embase and CINAHL for qualitative studies examining carer experiences of mental health inpatient care. Searches were supplemented by reference list screening and forward citation tracking of included studies. Results were synthesised using thematic synthesis. Our protocol was registered on PROSPERO (CRD42020197904) and our review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. FINDINGS Twelve studies were included from 6 countries. Four themes were identified: the emotional journey of inpatient care; invisible experts; carer concerns about quality of care for their loved one; and relationships and partnership between carers, service users and staff. INTERPRETATION Greater attention should be paid to ensure carers are well-supported, well-informed, and included in care. More emphasis must be placed on fostering positive relationships between carers, service users and staff and in facilitating continuity of care across inpatient and community services to provide carers with a sense of security and predictability. Further research is needed to explore differences in experiences based on carer and service user characteristics and global context, alongside co-production with carers to develop and evaluate future guidelines and policies.
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Bank M, Roessler KK. Therapeutic Environments in Drug Treatment: From Stigmatising Spaces to Enabling Places. A Theory-Based Qualitative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095005. [PMID: 35564411 PMCID: PMC9102114 DOI: 10.3390/ijerph19095005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 12/04/2022]
Abstract
Investigating therapeutic environments for young drug users is needed to avoid a high dropout rate due to a potential stigmatising effect of the structure of the space. In this article, we draw from three semi-structured interviews with young drug users. The interviews focused broadly on their experiences being on drug treatment and on how they experienced counselling and treatment in different spaces. The findings show that therapeutic spaces that were viewed as clinical and sterile were experienced as stigmatising, which discouraged young drug users from engaging in treatment and therapeutic processes. In contrast, therapeutic places with a homely atmosphere reduced the experience of stigmatisation, facilitated participation in treatment and helped users to relax and feel part of a community. In the analysis, we show how enabling therapeutic places with a homely atmosphere can be produced through materials, activities, and sensory processes.
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Oeljeklaus L, Schmid HL, Kornfeld Z, Hornberg C, Norra C, Zerbe S, McCall T. Therapeutic Landscapes and Psychiatric Care Facilities: A Qualitative Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031490. [PMID: 35162518 PMCID: PMC8835684 DOI: 10.3390/ijerph19031490] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 01/27/2023]
Abstract
The environment in healthcare facilities can influence health and recovery of service users and furthermore contribute to healthy workplaces for staff. The concept of therapeutic landscapes seems to be a promising approach in this context. The aim of this qualitative meta-analysis is to review the effects of therapeutic landscapes for different stakeholders in psychiatric care facilities. A systematic literature search was conducted in the four data bases PubMed, PsycInfo, CINAHL, and Web of Science. Thirteen predominately qualitative studies were included in this qualitative meta-analysis. The methodological quality of these qualitative studies was assessed, using an adapted version of the Journal Article Reporting Standards for Qualitative Research, and a thematic analysis was conducted. The results were categorised into the three main themes of the physical (built and natural), social, and symbolic dimensions of the therapeutic landscape. Given the heterogeneity of the summarised data and an overall methodological quality of the included studies that can be rated as medium, the results should be interpreted with caution. Current findings are based almost exclusively on qualitative studies. Therefore, there is a need for quantitative study designs that investigate the relationship between specific environmental elements and mental health outcomes for different stakeholders in psychiatric facilities.
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Affiliation(s)
- Lydia Oeljeklaus
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Hannah-Lea Schmid
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
| | - Zachary Kornfeld
- LWL-Hospital Paderborn, Psychiatry Psychotherapy Psychosomatic, 33098 Paderborn, Germany; (Z.K.); (C.N.)
- Medical Faculty, Ruhr University Bochum, 44801 Bochum, Germany
| | - Claudia Hornberg
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
| | - Christine Norra
- LWL-Hospital Paderborn, Psychiatry Psychotherapy Psychosomatic, 33098 Paderborn, Germany; (Z.K.); (C.N.)
- Medical Faculty, Ruhr University Bochum, 44801 Bochum, Germany
| | - Stefan Zerbe
- Faculty of Science and Technology, Free University of Bozen-Bolzano, 39100 Bolzano, Italy;
| | - Timothy McCall
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
- Correspondence: ; Tel.: +49-521-106-67898
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Missouridou E, Fradelos EC, Kritsiotakis E, Mangoulia P, Segredou E, Papathanasiou IV. Containment and therapeutic relationships in acute psychiatric care spaces: the symbolic dimensions of doors. BMC Psychiatry 2022; 22:2. [PMID: 34983447 PMCID: PMC8725636 DOI: 10.1186/s12888-021-03607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is an increasing trend of door locking practices in acute psychiatric care. The aim of the present study was to illuminate the symbolic dimensions of doors in Greek mental health nurses' experiences of open and locked working spaces. RESULTS A sequential mixed-method designexplored the experiences of nurses working in both open and locked psychiatric acute care units. Participants experiences revealed four types of doors related to the quality of recovery-oriented care: (a) the open door, (b) the invisible door, (c) the restraining door, and (d) the revolving door. Open doors and permeable spacesgenerated trust and facilitated the diffusion of tension and the necessary perception of feeling safe in order to be involved in therapeutic engagement. When the locked unit was experienced as a caring environment, the locked doors appeared to be "invisible". The restraining doors symbolized loss of control, social distance and stigma echoing the consequences of restrictingpeople's crucial control over spaceduring the COVID-19 pandemicin relation toviolence within families, groups and communities. The revolving door (service users' abscondence/re-admission) symbolised the rejection of the offered therapeutic environment and was a source of indignation and compassion fatigue in both open and locked spaces attributed to internal structural acute care characteristics (limited staffing levels, support, resources and activities for service users) as well as 'locked doors' in the community (limited or no care continuity and stigma). CONCLUSIONS The impact of COVID-19 restrictions on people's crucial control of space provides an impetus for erecting barriers masked by the veil of habit and reconsidering the impact of the simple act of leaving the door open/locked to allow both psychiatric acute care unit staff and service users to reach their potential.
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Affiliation(s)
- Evdokia Missouridou
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Saint Spiridonos 12243, Egaleo, Athens, Greece.
| | - Evangelos C. Fradelos
- grid.410558.d0000 0001 0035 6670Community Nursing Lab, Department of Nursing, University of Thessaly, Larissa, Greece
| | - Emmanouel Kritsiotakis
- grid.499377.70000 0004 7222 9074 Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Saint Spiridonos 12243, Egaleo, Athens, Greece ,Psychiatric Department, General State Hospital “Sismanoglio”, Marousi, Greece
| | - Polyxeni Mangoulia
- grid.499377.70000 0004 7222 9074 Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Saint Spiridonos 12243, Egaleo, Athens, Greece ,Psychiatric Liaison Unit, General State Hospital “Evangelismos”, Athens, Greece
| | - Eirini Segredou
- Alcohol Treatment Unit, Psychiatric Hospital of Attica, Chaidari, Greece
| | - Ioanna V. Papathanasiou
- grid.410558.d0000 0001 0035 6670Community Nursing Lab, Department of Nursing, University of Thessaly, Larissa, Greece
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Taheri S, Ghasemi Sichani M, Shabani A. Evaluating the literature of therapeutic landscapes with an emphasis on the search for the dimensions of health: A systematic review. Soc Sci Med 2021; 275:113820. [PMID: 33721742 DOI: 10.1016/j.socscimed.2021.113820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/01/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
Health geography emphasizes landscape capacity as a perspective for examining health dimensions. Much of this emphasis is on the concept of therapeutic landscapes. In the last two decades, changes in the therapeutic landscapes concerning health, as well as why and how the development of the emphasis on the dimensions of the health in the landscape in proportion to the temporal-spatial course of literature in this field can be considered. The framework of the present study is based on a systematic review of therapeutic landscapes in the geography of health in the last two decades. This systematic literature review followed the PRISMA guidelines. Searching for "Therapeutic Landscapes" term at Science Direct and PubMed, screening, 56 eligible articles were selected in the journal Social Science and Medicine, and Health and Place. The results of the systematic review, aiming to search for the health dimensions of the therapeutic landscape, and recognize main gaps, identified three main issues: scale and range of users of therapeutic landscapes, the position importance of experiences in therapeutic landscapes, therapeutic landscapes as the holistic paradigm. The results of the research show that in recent years, attention to multiple dimensions of health, especially non-physical relationships of therapeutic landscapes and multiple dimensions of health, has been considered more and more by researchers. Personal-social perceptions and experiences are also continually evolving, so the concept of therapeutic landscapes and its relationship to health is considered living and dynamic.
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Affiliation(s)
- Shima Taheri
- Department of Architecture, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran; Young Researchers and Elite Club, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
| | - Maryam Ghasemi Sichani
- Department of Architecture, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran; Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
| | - Amirhosein Shabani
- Department of Urban planning, Najafabad Branch, Islamic Azad University, Najafabad, Iran; Advancement in Architecture and Urban planning Research Center, Najafabad Branch, Islamic Azad University, Najafabad, Iran.
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15
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Mutual visibility and interaction: staff reactions to the ‘healing architecture’ of psychiatric inpatient wards in Denmark. BIOSOCIETIES 2020. [DOI: 10.1057/s41292-020-00195-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Jovanović N, Campbell J, Priebe S. How to design psychiatric facilities to foster positive social interaction – A systematic review. Eur Psychiatry 2020; 60:49-62. [DOI: 10.1016/j.eurpsy.2019.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/15/2022] Open
Abstract
AbstractPsychiatric facilities are often criticised of being poorly designed which may contribute to violent incidents and patients’ complaints of feeling bored and lacking meaningful interactions with peers and staff. There is a lack of understanding how to design environments for staff, patients and visitors to engage in positive social interactions (e.g. conversation, sharing, peer support). We conducted a systematic literature review on which architectural typologies and design solutions facilitate helpful social interactions between users of psychiatric facilities. Several interventions were identified such as choosing a community location; building smaller (up to 20 beds) homelike and well integrated facilities with single/double bedrooms and wide range of communal areas; provision of open nursing stations; ensuring good balance between private and shared spaces for patients and staff; and specific interior design interventions such as arranging furniture in small, flexible groupings, introduction of plants on wards, and installing private conversation booths. These interventions range from simple and non-costly to very complex ones. The evidence should inform the design of new hospitals and the retrofitting of existing ones.
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17
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Muusse C, Kroon H, Mulder CL, Pols J. Working on and with Relationships: Relational Work and Spatial Understandings of Good Care in Community Mental Healthcare in Trieste. Cult Med Psychiatry 2020; 44:544-564. [PMID: 32246246 PMCID: PMC7497456 DOI: 10.1007/s11013-020-09672-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Deinstitutionalization is often described as an organizational shift of moving care from the psychiatric hospital towards the community. This paper analyses deinstitutionalization as a daily care practice by adopting an empirical ethics approach instead. Deinstitutionalization of mental healthcare is seen as an important way of improving the quality of lives of people suffering from severe mental illness. But how is this done in practice and which different goods are strived for by those involved? We examine these questions by giving an ethnographic description of community mental health care in Trieste, a city that underwent a radical process of deinstitutionalization in the 1970s. We show that paying attention to the spatial metaphors used in daily care direct us to different notions of good care in which relationships are central. Addressing the question of how daily care practices of mental healthcare outside the hospital may be constituted and the importance of spatial metaphors used may inform other practices that want to shape community mental health care.
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Affiliation(s)
- Christien Muusse
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands. .,Section of Medical Ethics, Department of General Practice, UMC Amsterdam, Amsterdam, The Netherlands.
| | - Hans Kroon
- grid.416017.50000 0001 0835 8259Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands ,grid.12295.3d0000 0001 0943 3265Tranzo, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Cornelis L. Mulder
- grid.5645.2000000040459992XErasmus MC, Rotterdam, The Netherlands ,Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Jeannette Pols
- Section of Medical Ethics, Department of General Practice, UMC Amsterdam, Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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18
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Hielscher E, Diminic S, Harris M, Castle D, Lee YY, Kealton J, Whiteford H. Impact of the carer on length of hospital stay for mental health: Results from two Australian surveys. Int J Ment Health Nurs 2019; 28:436-447. [PMID: 30246493 DOI: 10.1111/inm.12543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
Informal carers play a vital role in supporting Australians living with a mental illness, including during the acute phases of illness; however, little is known about their impact on length of hospital stay. We aimed to investigate the impact of having a carer and of carer burden on length of hospital stay for mental health. Two Australian datasets were used. Data from the 2010 National Survey of High Impact Psychosis (n = 1825) were used to investigate the impact of having versus not having a carer on length of hospital stay for mental health. Data from the UQ Carer Survey 2016 (n = 105), a convenience sample of mental health carers, were used to investigate the impact of weekly hours of care (a measure of objective carer burden) on length of stay. Multiple logistic regression and correlation analyses were performed to investigate the association between carer status/burden and length of stay. Having a carer was associated with a significantly longer length of hospital stay; however, this relationship was no longer significant after adjusting for diagnosis, global functioning, depressive symptoms, deliberate self-harm, mental health outpatient contacts and type of admission. Weekly hours of care did not significantly impact on length of stay. Patients with carers had poorer functioning which may be related to longer stays. Our analysis was not able to look at subgroups of carers with different needs. Future work is required to determine other components of the admission and discharge process where having a carer is influential.
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Affiliation(s)
- Emily Hielscher
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sandra Diminic
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Meredith Harris
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - David Castle
- University of Melbourne and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Yong Yi Lee
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jan Kealton
- Carer Consultant, Gold Coast, Queensland, Australia
| | - Harvey Whiteford
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, Queensland, Australia.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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19
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Reavey P, Brown S, Kanyeredzi A, McGrath L, Tucker I. Agents and spectres: Life-space on a medium secure forensic psychiatric unit. Soc Sci Med 2019; 220:273-282. [DOI: 10.1016/j.socscimed.2018.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/25/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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20
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Brunero S, Ramjan LM, Salamonson Y, Nicholls D. A constructivist grounded theory of generalist health professionals and their mental health work. Int J Ment Health Nurs 2018; 27:1816-1825. [PMID: 29847017 DOI: 10.1111/inm.12489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2018] [Indexed: 11/30/2022]
Abstract
Generalist health professionals, often without formal mental health training, provide treatment and care to people with serious mental illness who present with physical health problems in general hospital settings. This article will present findings from a constructivist grounded theory study of the work delivered by generalist health staff to consumers with mental illness on the general medical/surgical wards of two metropolitan hospitals in Sydney, Australia. The results analysed included three participant observations, two focus groups, and 21 interviews and hospital policy and protocol documents. A substantive theory of mental health work in general hospital settings is illustrated which conceptualizes the following categories: (i) the experience: conflicting realities and ideals; (ii) The Context: facilitating social distancing; and (iii) the social processes: invisibility affecting confidence. The categories are understood through the theoretical lens of symbolic interactionism with the theory providing insights into how the generalist health professionals understand their sense of self or identity.
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Affiliation(s)
- Scott Brunero
- Prince of Wales Hospital, Randwick, New South Wales, Australia.,School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Lucie M Ramjan
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.,Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Yenna Salamonson
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia.,Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Daniel Nicholls
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
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21
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Clarke JM, Waring J. The transformative role of interaction rituals within therapeutic communities. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1277-1293. [PMID: 29956341 PMCID: PMC6282779 DOI: 10.1111/1467-9566.12773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mental health settings are fraught with emotion as clients address difficult life experiences and relational patterns. Clients spend a substantial amount of time together outside of structured therapy, but little is known about how these moments are potentially therapeutic, especially as sites of emotional change. We draw on interaction ritual chain theory to explore how negative emotions in situations outside of formal therapy can be transformed into positive emotions and facilitate personal change. The research is based upon a narrative ethnography of two therapeutic communities for individuals with a diagnosis of personality disorder. Despite the presence of negative transient emotions in these rituals, clients experienced positive feelings of solidarity and belonging, and the majority of clients reported increased feelings of confidence and positive change. Conversely, dynamics between clients showed clients were not always supportive of one another and at times, could exclude others, resulting in isolation and alienation. We argue interactions that generate feelings of inclusion or exclusion over time are a key component in whether clients gain positive or negative emotional feeling and experience personal change.
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Affiliation(s)
| | - Justin Waring
- Business School NorthUniversity of NottinghamNottinghamUK
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22
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Punzi E, Singer C. ‘Any room won’t do.’ Clinical psychologists’ understanding of the consulting room. An interview study. PSYCHODYNAMIC PRACTICE 2018. [DOI: 10.1080/14753634.2018.1526107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Elisabeth Punzi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Singer
- Institut für Anglistik und Amerikanistik, University of Paderborn, Germany
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23
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Susanti H, Lovell K, Mairs H. What does the literature suggest about what carers need from mental health services for their own wellbeing? A Systematic Review. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30047-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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24
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Bell SL, Foley R, Houghton F, Maddrell A, Williams AM. From therapeutic landscapes to healthy spaces, places and practices: A scoping review. Soc Sci Med 2018; 196:123-130. [DOI: 10.1016/j.socscimed.2017.11.035] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/18/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
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25
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Bailey JM, Wye PM, Wiggers JH, Bartlem KM, Bowman JA. Family carers: A role in addressing chronic disease risk behaviours for people with a mental illness? Prev Med Rep 2017; 7:140-146. [PMID: 28660122 PMCID: PMC5480275 DOI: 10.1016/j.pmedr.2017.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 05/21/2017] [Accepted: 05/28/2017] [Indexed: 12/05/2022] Open
Abstract
People with a mental illness experience greater chronic disease morbidity and mortality compared to those without mental illness. Family carers have the potential to promote the health behaviours of those they care for however factors which may influence the extent to which they do so have not been reported. An exploratory study was conducted to investigate carers': 1) promotion of fruit and vegetable consumption, physical activity, quitting smoking, and reducing alcohol consumption; 2) perceptions of their role and ability to promote such behaviours; 3) and the association between carer perceptions and the promotion of such behaviours. A cross-sectional survey was conducted with mental health carers (N = 144, 37.6% response rate) in New South Wales, Australia in 2013. Associations between current promotion of health behaviours and carer perceptions were explored through multivariate regression analysis in 2016. A majority of respondents promoted fruit and vegetable consumption (63.8%), physical activity (60.3%), quitting smoking (56.3%), and reducing alcohol consumption (56.2%) to the person they cared for. A perception that it was ‘very important’ to have a positive influence on these behaviours was positively related with promotion of each of the four behaviours, with those holding such a view being more likely to promote such behaviours, than those who did not (odds ratio: 9.47–24.13, p < 0.001). The majority (56.2%–63.8%) of carers reported promoting the health behaviours of those they cared for, demonstrating a need and opportunity to build the capacity of carers to contribute to reducing the health risk behaviours among people with a mental illness. A majority of carers reported current promotion of all four health risk behaviours. Carer capacity to influence behaviours may be limited by several factors. Carer capacity may also be limited differentially for different behaviours. Carers were more likely to promote health behaviours if they perceived it important.
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Affiliation(s)
- Jacqueline M Bailey
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Paula M Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.,Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia
| | - John H Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.,Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Kate M Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.,Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287, Australia
| | - Jennifer A Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
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26
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Ergun G, Isik I, Dikec G. Roles of Psychiatry Nurses Within a Therapeutic Environment of Psychiatry Clinics in Turkey. Arch Psychiatr Nurs 2017; 31:248-255. [PMID: 28499563 DOI: 10.1016/j.apnu.2016.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/30/2016] [Accepted: 11/10/2016] [Indexed: 11/28/2022]
Abstract
OBJECT The object of this study is to determine the roles of psychiatry nurses within the therapeutic environment of psychiatry clinics in Turkey. METHODS This study was performed in a cross-sectional and descriptive design in 195 institutes comprising psychiatry clinics in Turkey. RESULTS When the responsibilities of nurses for clinical activities were asked, the following answers were obtained: playing with patients or painting at a rate of 54,4%. It was determined that in the majority of psychiatry clinics, there were educational activities which were conducted by nurses. CONCLUSION The researchers propose that the increase in the roles and responsibilities of nurses in such activities be supported.
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Affiliation(s)
- Gul Ergun
- Mehmet Akif Ersoy University, Faculty of Health Science, Department of Emergency Services and Disaster Management, İstiklal Campus, 15300 Burdur, Turkey.
| | - Isil Isik
- Yeditepe University, Faculty of Health Science, Department of Nursing, İstanbul, Turkey
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27
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Smoking Cessation Care for People with a Mental Illness: Family Carer Expectations of Health and Community Services. J Smok Cessat 2016. [DOI: 10.1017/jsc.2016.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction: Smoking prevalence remains high among people with a mental illness, contributing to higher levels of morbidity and mortality. Health and community services are an opportune setting for the provision of smoking cessation care. Although family carers are acknowledged to play a critical role in supporting the care and assistance provided by such services to people with a mental illness, their expectations regarding the delivery of smoking cessation care have not been examined.Aims: To explore family carer expectations of smoking cessation care provision by four types of health services, to clients with a mental illness, and factors associated with expectations.Methods: A cross-sectional survey was conducted with carers of a person with a mental illness residing in New South Wales, Australia. Carers were surveyed regarding their expectations of smoking cessation care provision from four types of health services. Possible associations between carer expectation of smoking cessation care provision and socio-demographic and attitudinal variables were explored.Results: Of 144 carers, the majority of carers considered that smoking cessation care should be provided by: mental health hospitals (71.4%), community mental health services (78.0%), general practice (82.7%), and non-government organisations (56.6%). The factor most consistently related to expectation of care was a belief that smoking cessation could positively impact mental health.Conclusions: The majority of carers expected smoking cessation treatment to be provided by all services catering for people with a mental illness, reinforcing the appropriateness for such services to provide smoking cessation care for clients in an effective and systematic manner.
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28
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Fondevilla HL, Iwata Y. Student participation in arts in hospital projects in Japan. Arts Health 2016. [DOI: 10.1080/17533015.2015.1033435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Norvoll R, Pedersen R. Exploring the views of people with mental health problems' on the concept of coercion: Towards a broader socio-ethical perspective. Soc Sci Med 2016; 156:204-11. [PMID: 27054304 DOI: 10.1016/j.socscimed.2016.03.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 12/07/2015] [Accepted: 03/23/2016] [Indexed: 11/24/2022]
Abstract
In mental health care, coercion is a controversial issue that has led to much debate and research on its nature and use. Yet, few previous studies have explicitly explored the views on the concept of coercion among people with first-hand experiences of being coerced. This study includes semi-structured focus-groups and individual interviews with 24 participants who had various mental health problems and experiences with coercion. Data were collected in 2012-2013 in three regions of Norway and analysed by a thematic content analysis. Findings show that participants had wide-ranging accounts of coercion, including formal and informal coercion across health- and welfare services. They emphasised that using coercion reflects the mental health system's tendency to rely on coercion and the lack of voluntary services and treatment methods that are more helpful. Other core characteristics of coercion were deprivation of freedom, power relations, in terms of powerlessness and 'counter-power,' and coercion as existential and social life events. Participants' views are consistent with prevailing theories of coercion and research on perceived coercion. However, this study demonstrates a need for broader existential and socio-ethical perspectives on coercion that are intertwined with treatment and care systems in research and practice. Implications for mental health policy and services are discussed.
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Affiliation(s)
- Reidun Norvoll
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Postbox 1130 Blindern, 0318 Oslo, Norway.
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Postbox 1130 Blindern, 0318 Oslo, Norway.
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30
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Ahern CC, Bieling P, McKinnon MC, McNeely HE, Langstaff K. A Recovery-Oriented Care Approach: Weighing the Pros and Cons of a Newly Built Mental Health Facility. J Psychosoc Nurs Ment Health Serv 2016; 54:39-48. [DOI: 10.3928/02793695-20160119-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/09/2015] [Indexed: 11/20/2022]
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31
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Giles-Vernick T, Bainilago L, Fofana M, Bata P, Vray M. Home Care of Children With Diarrhea in Bangui's Therapeutic Landscape (Central African Republic). QUALITATIVE HEALTH RESEARCH 2016; 26:164-175. [PMID: 25646000 DOI: 10.1177/1049732315570117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We explore how the therapeutic landscape of Bangui, capital of the Central African Republic, shaped and reflected caregivers' home care of childhood diarrhea. Using interviews, group discussions, and participant observation, we found that caregivers described several categories of diarrhea, but in practice, adopted an experimental approach to home diarrheal care. Many managed incertitude by initially dosing children with street medicines and herbal infusions; they delayed seeking professional medical care to avoid expenses, observed their children's symptoms, consulted social networks, and used therapeutic foods. The logics underpinning these practices emerged from caregivers' conviction that diarrhea necessitated medical therapy and restricted choices within Bangui's therapeutic landscape, a consequence of lengthy political economic crisis. This crisis impoverished Bangui populations, eroded formal health care, and sharpened religious differences, discouraging care seeking from traditional healers. Analyses of therapeutic landscapes illuminate why caregivers embraced specific practices and logics and should guide the elaboration of more effective public health interventions.
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Affiliation(s)
| | | | - Moussa Fofana
- Université de Bangui, Bangui, Central African Republic
| | - Petulla Bata
- Centre Pédiatrique, Bangui, Central African Republic
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32
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Martin D, Nettleton S, Buse C, Prior L, Twigg J. Architecture and health care: a place for sociology. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:1007-1022. [PMID: 25929329 DOI: 10.1111/1467-9566.12284] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sociologists of health and illness have tended to overlook the architecture and buildings used in health care. This contrasts with medical geographers who have yielded a body of work on the significance of places and spaces in the experience of health and illness. A review of sociological studies of the role of the built environment in the performance of medical practice uncovers an important vein of work, worthy of further study. Through the historically situated example of hospital architecture, this article seeks to tease out substantive and methodological issues that can inform a distinctive sociology of healthcare architecture. Contemporary healthcare buildings manifest design models developed for hotels, shopping malls and homes. These design features are congruent with neoliberal forms of subjectivity in which patients are constituted as consumers and responsibilised citizens. We conclude that an adequate sociology of healthcare architecture necessitates an appreciation of both the construction and experience of buildings, exploring the briefs and plans of their designers, and observing their everyday uses. Combining approaches and methods from the sociology of health and illness and science and technology studies offers potential for a novel research agenda that takes healthcare buildings as its substantive focus.
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Affiliation(s)
| | | | - Christina Buse
- School of Sociology and Social Policy, University of Leeds, UK
| | - Lindsay Prior
- School of Sociology, Social Policy & Social Work, Queen's University, Belfast, UK
| | - Julia Twigg
- School of Social Policy, Sociology and Social Research, University of Kent, UK
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Wood VJ, Gesler W, Curtis SE, Spencer IH, Close HJ, Mason J, Reilly JG. 'Therapeutic landscapes' and the importance of nostalgia, solastalgia, salvage and abandonment for psychiatric hospital design. Health Place 2015; 33:83-9. [PMID: 25796009 DOI: 10.1016/j.healthplace.2015.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/25/2015] [Accepted: 02/20/2015] [Indexed: 11/16/2022]
Abstract
We examine emotional reactions to changes to medical spaces of care, linked with past experiences. In this paper we draw on findings from a qualitative study of the transfer of psychiatric inpatient care from an old to a newly built facility. We show how the meanings attributed to 'therapeutic landscapes' from one׳s past can evoke emotions and memories, manifesting in ideas about nostalgia, solastalgia, salvage and abandonment, which can impinge on one׳s present therapeutic experience. We reflect on how consideration of these ideas might contribute to better future design of psychiatric inpatient facilities and the wellbeing of those using them.
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Affiliation(s)
- Victoria J Wood
- Department of Geography, Durham University, South Road, Durham DH1 3LE, UK.
| | - Wil Gesler
- University of North Carolina, Chapel Hill, USA
| | - Sarah E Curtis
- Department of Geography, Durham University, South Road, Durham DH1 3LE, UK
| | - Ian H Spencer
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University, TS17 6BH, UK
| | - Helen J Close
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University, TS17 6BH, UK
| | - James Mason
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University, TS17 6BH, UK
| | - Joe G Reilly
- School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University, TS17 6BH, UK
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Houghton F, Houghton S. Therapeutic micro-environments in the Edgelands: A thematic analysis of Richard Mabey's The Unofficial Countryside. Soc Sci Med 2014; 133:280-6. [PMID: 25467881 DOI: 10.1016/j.socscimed.2014.11.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The concept of therapeutic landscapes, as introduced by Gesler, has had a significant impact on what has become a reformed geography (or geographies) of health. Research in this field has developed the number and type of sites that have been characterised as therapeutic landscapes. A wide range of environments have now been explored through the analytical lens of the 'therapeutic landscape'. This research further expands current descriptions of such environments by exploring Edgelands as therapeutic micro landscapes. Edgelands refer to the neglected and routinely ignored interfacial zone between urban and rural that are a routine characteristic of the urban fringe resulting from dynamic cycles of urban development and decay. Using a hybrid method of thematic analysis incorporating both inductive and deductive approaches, this research explores Richard Mabey's seminal work on this topic, The Unofficial Countryside. Previous examinations of the features of therapeutic environments are therefore scrutinised to explore both scale and the possibility of further extending the kind of environments that may be described as therapeutic to include Edgelands. This approach is informed, in part, by principles of mindfulness, a historically Eastern, but increasingly Western approach to exploring oneself and the environment. This research identifies that these overlooked and neglected landscapes are in fact vibrant, resilient and enthralling environments teeming with life, renewal and re-birth. Examination reveals that there are three crucial outcomes of this research. The first relates to the issue of scale. Mabey's book provides evidence of the importance of micro environments in providing a therapeutic environmental focus. Secondly, this research explores the potential of mindfulness as an approach in Geography. Lastly, this research also identifies Edgelands as therapeutic sites and calls for an increased understanding and appreciation of their potential.
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Affiliation(s)
- Frank Houghton
- College of Health Science & Public Health, Eastern Washington University, Spokane, WA, USA.
| | - Sharon Houghton
- Department of Psychology, University of Limerick, Limerick, Ireland
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Fenton K, Larkin M, Boden ZVR, Thompson J, Hickman G, Newton E. The experiential impact of hospitalisation in early psychosis: service-user accounts of inpatient environments. Health Place 2014; 30:234-41. [PMID: 25460906 DOI: 10.1016/j.healthplace.2014.09.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 09/22/2014] [Accepted: 09/25/2014] [Indexed: 11/19/2022]
Abstract
Early Intervention in Psychosis services aim to keep young people out of hospital, but this is not always possible. This research used in-depth interviews to explore the experience of hospitalisation amongst young people with psychosis. Findings describe fear and confusion at admission, conflicting experiences of the inpatient unit as both safe and containing, and unsafe and chaotic, and the difficult process of maintaining identity in light of the admission. We discuss the need to move from construing psychiatric hospitals as places for 'passive seclusion', to developing more permeable and welcoming environments that can play an active role in recovery.
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Affiliation(s)
- Kelly Fenton
- University of Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, UK
| | | | | | - Jessica Thompson
- University of Birmingham, UK; St. Andrews Healthcare, Birmingham, UK
| | - Gareth Hickman
- University of Birmingham, UK; Coventry and Warwickshire Partnership Trust, UK
| | - Elizabeth Newton
- University of Birmingham, UK; Coventry and Warwickshire Partnership Trust, UK
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Al-Sagarat A, Moxham L, Curtis J, Crooke P. The perceptions of the ward atmosphere in four Jordanian psychiatric hospitals from the perspective of patients' relatives. Perspect Psychiatr Care 2014; 50:287-93. [PMID: 24383814 DOI: 10.1111/ppc.12057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 11/07/2013] [Accepted: 11/07/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To describes the perceptions of the ward atmosphere of psychiatric hospitals from the perspective of the relatives of people who were inpatients in those hospitals. DESIGN AND METHODS A nonexperimental descriptive survey was used. Data were collected using the Arabic version of Moos Ward Atmosphere Scale Ideal and Real forms. FINDINGS Data indicate that even though relatives of Jordanian mental health patients were generally positive about the ward atmosphere, they would like to see changes. PRACTICE IMPLICATIONS By describing their current and ideal treatment environments, participants have provided information that can guide interventions to change the ward atmosphere and thus help foster better patient treatment outcomes.
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Affiliation(s)
- Ahmad Al-Sagarat
- Department of Community Health and Mental Health Nursing, Faculty of Nursing, Mu'tah University, AL-Karak, Jordan
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Papoulias C, Csipke E, Rose D, McKellar S, Wykes T. The psychiatric ward as a therapeutic space: systematic review. Br J Psychiatry 2014; 205:171-6. [PMID: 25179622 DOI: 10.1192/bjp.bp.114.144873] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hospital care is still an integral part of mental healthcare services. But the impact of ward design on treatment outcomes is unclear. AIMS To review the effects of ward design on patient outcomes and patient and staff well-being. METHOD A systematic review of literature was carried out on Medline, Embase and PsycINFO. Papers on psychogeriatric and child and adolescent wards were excluded as these necessitate specific safety features. RESULTS Twenty-three papers were identified. No strong causal links between design and clinical outcomes were found. Private spaces and a homely environment may contribute to patient well-being. Different stakeholders may experience ward design in conflicting ways; design has a symbolic and social dimension for patients. CONCLUSIONS Data on the impact of design on treatment outcomes are inconclusive. Rigorous randomised controlled trials, qualitative studies and novel methods are called for. Different stakeholders' responses to the ward as a symbolic environment merit further investigation.
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Affiliation(s)
- Constantina Papoulias
- Constantina Papoulias, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Emese Csipke, PhD, Department of Psychology, Institute of Psychiatry, King's College London; Diana Rose, PhD, Susie McKellar, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Til Wykes, PhD, Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Emese Csipke
- Constantina Papoulias, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Emese Csipke, PhD, Department of Psychology, Institute of Psychiatry, King's College London; Diana Rose, PhD, Susie McKellar, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Til Wykes, PhD, Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Diana Rose
- Constantina Papoulias, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Emese Csipke, PhD, Department of Psychology, Institute of Psychiatry, King's College London; Diana Rose, PhD, Susie McKellar, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Til Wykes, PhD, Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Susie McKellar
- Constantina Papoulias, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Emese Csipke, PhD, Department of Psychology, Institute of Psychiatry, King's College London; Diana Rose, PhD, Susie McKellar, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Til Wykes, PhD, Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Til Wykes
- Constantina Papoulias, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Emese Csipke, PhD, Department of Psychology, Institute of Psychiatry, King's College London; Diana Rose, PhD, Susie McKellar, PhD, Service User Research Enterprise, Institute of Psychiatry, King's College London; Til Wykes, PhD, Department of Psychology, Institute of Psychiatry, King's College London, UK
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Brewster L. The public library as therapeutic landscape: a qualitative case study. Health Place 2014; 26:94-9. [PMID: 24418525 DOI: 10.1016/j.healthplace.2013.12.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
The idea of the therapeutic landscape has been widely used to describe the relationship between place and improvements in mental health. This paper uses data from a qualitative study conducted with people with mental health problems to outline the role of the public library as a therapeutic landscape. It situates the public library as a space that is simultaneously familiar and welcoming, comforting and calming, and empowering. Further, the paper reflects on the impact of proposed library closures in light of these previously hidden benefits, thinking about the library's role as an environment and not as a service provider.
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Affiliation(s)
- Liz Brewster
- Social Science Applied to Healthcare Improvement Research Group (SAPPHIRE), Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK.
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Wood VJ, Curtis SE, Gesler W, Spencer IH, Close HJ, Mason JM, Reilly JG. Spaces for smoking in a psychiatric hospital: social capital, resistance to control, and significance for 'therapeutic landscapes'. Soc Sci Med 2013; 97:104-11. [PMID: 24161095 DOI: 10.1016/j.socscimed.2013.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 07/02/2013] [Accepted: 08/09/2013] [Indexed: 12/11/2022]
Abstract
This paper reports on research framed by theories of therapeutic landscapes and the ways that the social, physical and symbolic dimensions of landscapes relate to wellbeing and healing. We focus especially on the question of how attributes of therapeutic landscapes are constructed in different ways according to the variable perspectives of individuals and groups. Through an ethnographic case study in a psychiatric hospital in the North of England we explore the perceived significance for wellbeing of 'smoking spaces' (where tobacco smoking is practiced in ways that may, or may not be officially sanctioned). We interpret our findings in light of literature on how smoking spaces are linked to the socio-geographical power relations that determine how smoking is organised within the hospital and how this is understood by different groups using the hospital building. We draw on qualitative research findings from discussion groups, observations, and interviews with patients, carers and staff. These focused on their views about the building design and setting of the new psychiatric hospital in relation to their wellbeing, and issues relating to smoking spaces emerged as important for many participants. Creating and managing smoking spaces as a public health measure in psychiatric hospitals is shown to be a controversial issue involving conflicting aims for health and wellbeing of patients and staff. Our findings indicate that although from a physical health perspective, smoking is detrimental, the spaces in which patients and staff smoke have social and psychological significance, providing a forum for the creation of social capital and resistance to institutional control. While the findings relate to one case study setting, the paper illustrates issues of wider relevance and contributes to an international literature concerning the tensions between perceived psychological and psychosocial benefits of smoking vs. physical harm that smoking is likely to cause. We consider the implications for hospital design and the model of care.
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Affiliation(s)
- Victoria J Wood
- Department of Geography, Durham University, Wolfson Research Institute, Queens Campus, Stockton-on-Tees DH17 6BH, UK.
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Curtis S, Gesler W, Wood V, Spencer I, Mason J, Close H, Reilly J. Compassionate containment? Balancing technical safety and therapy in the design of psychiatric wards. Soc Sci Med 2013; 97:201-9. [PMID: 23916450 DOI: 10.1016/j.socscimed.2013.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 04/22/2013] [Accepted: 06/13/2013] [Indexed: 11/13/2022]
Abstract
This paper contributes to the international literature examining design of inpatient settings for mental health care. Theoretically, it elaborates the connections between conceptual frameworks from different strands of literature relating to therapeutic landscapes, social control and the social construction of risk. It does so through a discussion of the substantive example of research to evaluate the design of a purpose built inpatient psychiatric health care facility, opened in 2010 as part of the National Health Service (NHS) in England. Findings are reported from interviews or discussion groups with staff, patients and their family and friends. This paper demonstrates a strong, and often critical awareness among members of staff and other participants about how responsibilities for risk governance of 'persons' are exercised through 'technical safety' measures and the implications for therapeutic settings. Our participants often emphasised how responsibility for technical safety was being invested in the physical infrastructure of certain 'places' within the hospital where risks are seen to be 'located'. This illuminates how the spatial dimensions of social constructions of risk are incorporated into understandings about therapeutic landscapes. There were also more subtle implications, partly relating to 'Panopticist' theories about how the institution uses technical safety to supervise its own mechanisms, through the observation of staff behaviour as well as patients and visitors. Furthermore, staff seemed to feel that in relying on technical safety measures they were, to a degree, divesting themselves of human responsibility for risks they are required to manage. However, their critical assessment showed their concerns about how this might conflict with a more therapeutic approach and they contemplated ways that they might be able to engage more effectively with patients without the imposition of technical safety measures. These findings advance our thinking about the construction of therapeutic landscapes in theory and in practice.
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Affiliation(s)
- Sarah Curtis
- Department of Geography, Durham University, South Road, Durham DH1 3LE, United Kingdom.
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