Lloyd-Evans, B.; (2010) Acute inpatient mental health wards and inpatient alternatives: a quantitative comparison of the care provided. Doctoral thesis , UCL (University College London).

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Abstract

Background: Literature indicates widespread dissatisfaction with UK acute psychiatric wards. Patients report boredom and insufficient time with staff. Residential alternatives to acute wards have been developed. Aims: 1) To review literature for the effectiveness and acceptability of alternatives 2) To identify or develop measures of content of care for acute inpatient and residential crisis services 3) To compare the content of care at alternatives and standard services and understand its relationship to patient satisfaction. Hypotheses tested were that alternatives provide greater total care, more social and psychological interventions but fewer physical and pharmacological interventions than standard wards. Method: A systematic review of studies evaluating alternatives was conducted. Measures of content of care were reviewed. New measures were developed (CaSPAR, CaRICE and CCCQ-P) and their psychometrics explored. Data were collected from 4 alternatives and 4 standard services using CaSPAR (n=224), CaRICE (1 recording week per service), CCCQ-P and CSQ (n=314). The relationship of service type, patient characteristics and CCCQ-P scores to patient satisfaction was explored. Results: The limited current evidence does not contra-indicate alternatives and suggests patient satisfaction may be greater at community alternatives than standard wards. No study hypotheses were corroborated. Sub-group analysis indicated community alternatives provided more psychological and less physical and pharmacological care than standard wards. All CCCQ-P variables were significantly associated with patient satisfaction. Patient satisfaction was greatest at community alternatives. It remained significantly greater at alternatives than standard wards after adjusting for CCCQ-P variables. Discussion: Community alternatives are a promising service model. Their greater acceptability than standard wards was not explained by measured differences in care. Intensity of care may influence patient satisfaction more than the types of intervention provided. Increasing staff-patient contact should be an aim for alternative and standard services. There may be differing, valid perspectives about what constitutes care: multi-methods assessment is required.

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