Architecture as change-agent? Looking for innovation in contemporary forensic psychiatric hospital design

2020 ◽  
pp. medhum-2020-011887
Author(s):  
Rebecca Mclaughlan ◽  
Codey Lyon ◽  
Dagmara Jaskolska
Keyword(s):  
Psychiatric Hospital ◽  
Mental Healthcare ◽  
Psychiatric Hospitals ◽  
Advisory Panel ◽  
Design Practice ◽  
Hospital Design ◽  
Hospitalised Patients ◽  
The Usa ◽  
Forensic Psychiatric ◽  
The Uk

History suggests that departures from accepted design practice can contribute to positive change in the delivery of mental healthcare, the daily experience of hospitalised patients and public perceptions of mental illness. Yet the question of how architecture can support the therapeutic journey of patients remains a critical one. The availability of evidence-based design literature to guide architects cannot keep pace with growing global demand for new forensic psychiatric hospital facilities. This article reports a global survey of current design practice to speculate on the potential of three new hospitals to positively improve patient experience. A desktop survey was conducted of 31 psychiatric hospitals (24 forensic, 7 non-forensic) constructed or scheduled for completion between 2006 and 2022. This was supplemented by advisory panel sessions with clinical/facilities staff, alongside architectural knowledge obtained through workshops with architects from the UK and the USA, and the inclusion of Australian architects on the research team. Data analysis draws on knowledge from architectural practice, architectural history and environmental psychology, arguing that there is a responsibility to integrate knowledge from across these disciplines in respect of such a pressing and important problem.

scholarly journals Exploring Ethnicity in Hospital Patients with COVID-19 in South London

The Physician ◽  
2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Anna Zatorska ◽  
Niladri Konar ◽  
Pratyasha Saha ◽  
Alice Moseley ◽  
Jessica Denman ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Population Distribution ◽  
Local Population ◽  
Case Series ◽  
Risk Of Death ◽  
Hospitalised Patients ◽  
Hospital Patients ◽  
The Usa ◽  
The Uk ◽  
The Impact

Ethnicity was found to be an independent risk factor in COVID-19 outcomes in the UK and the USA during the pandemic surge. London, being in the epicentre and having one of the most ethnically diverse population in the UK, was likely to have experienced a much higher intensity of this phenomenon. Black Asian and Minority ethnic groups were more likely to be admitted, more likely to require admission to intensive care, and more likely to die from COVID-19. We undertook an analysis of a case series to explore the impact of ethnicity in hospitalised patients with confirmed COVID-19 during the 3 months of the pandemic. Our results demonstrated that although the proportion of Asian and Black patients were representative of the local population distribution, they were much younger. The prevalence of comorbidities was similar but logistic regression analysis showed that male sex (OR 1.4, 95% CI 1.1-1.9; p=0.02), age (OR 1.03, 95% CI 1.02 - 1.04, p<0.001), those in the ‘Other’ [Odds ratio 1.7 (1.1-2.6) p = 0.01] and ‘Asian’[Odds ratio 1.8 (1.1-2.7) p=0.01], category were at higher risk of death in this cohort. Our results, therefore, are consistent with the overall data from the UK and USA indicating that ethnicity remains a significant additional risk and hence our clinical services must ensure that adequate provision is made to cater to this risk and research must be designed to understand the causes.   

Forensic care in Germany

2017 ◽  
Vol 41 (S1) ◽  
pp. S61-S61
Author(s):  
H. Dressing ◽  
H.J. Salize
Keyword(s):  
Psychiatric Hospital ◽  
Psychiatric Hospitals ◽  
Epidemiological Data ◽  
Mentally Ill Offenders ◽  
Legal Regulations ◽  
Forensic Patients ◽  
Penal Law ◽  
Forensic Psychiatric ◽  
Competing Interest ◽  
Legal Frameworks

Although the idea that offenders suffering from a mental disorder must primarily be considered as ill and should therefore be exempted from punishment is of considerable antiquity legal frameworks and key concepts, which are applied in this field, differ widely in European Union member States. The respective legal regulations and epidemiological data of Germany will be presented.In German penal law the question of the guilt of an offender is of central significance. Legal regulations on the placement and treatment of mentally ill offenders in a forensic psychiatric hospital are subsumed under the section “Measures on improvement and safety”. Section 63 of the German penal law provides for the temporally unlimited commitment to a forensic- psychiatric hospital.In accordance with section 64 of the German penal law addicted offenders can be committed to a detoxification center for a period of up to two years. The available epidemiological data show a clear increase in the admissions to forensic psychiatric hospitals and to detoxification centers since beginnings of the 1990s. Recently the German parliament passed a new law. The aim of the new law is to strengthen patients’ rights and to diminish the number of forensic patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Staff attitudes to a psychiatric hospital closure

1997 ◽  
Vol 21 (3) ◽  
pp. 139-141
Author(s):  
Nick Ardagh-Walter ◽  
Prakash Naik ◽  
David Tombs
Keyword(s):  
Psychiatric Hospital ◽  
Psychiatric Hospitals ◽  
Staff Attitudes ◽  
Staff Morale ◽  
Hospital Closures ◽  
Factors Influencing ◽  
Hospital Closure ◽  
Future Hospital ◽  
The Uk ◽  
Enoch Powell

Many psychiatric hospitals in the UK have closed. Factors influencing staff morale around the time of a hospital closure will affect the functioning of that institution. This study surveyed staff anxieties, attitudes and expectations in a major psychiatric hospital three weeks prior to its closure. We found evidence of widespread denial despite energetic dissemination of information. There were also significant differences between staff groups. Our findings will have implications for the management of future hospital closures.“We have to get it into our heads that a hospital is like a shell, a framework to contain certain processes, and when the processes are superseded, the shell must, most probably, be scrapped and the framework dismantled” (Enoch Powell, 1961).

scholarly journals Emergency work at an Inner London psychiatric hospital: a study of assessments made over six months

1993 ◽  
Vol 17 (2) ◽  
pp. 84-86 ◽  
Author(s):  
M. A. McPhillips ◽  
S. A. Spence
Keyword(s):  
Psychiatric Hospital ◽  
Psychiatric Hospitals ◽  
The Uk

Following the introduction of a 24 hour Emergency Clinic at the Maudsley Hospital in 1952, psychiatric hospitals across the UK have come to offer a similar but often smaller service.

scholarly journals Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

2016 ◽  
Vol 209 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Rashmi Patel ◽  
Edward Chesney ◽  
Alexis E. Cullen ◽  
Alex D. Tulloch ◽  
Matthew Broadbent ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Clinical Outcomes ◽  
Psychiatric Hospital ◽  
Hospital Admissions ◽  
Mental Healthcare ◽  
Psychiatric Hospitals ◽  
Healthcare Services ◽  
Clinical Population ◽  
Minority Ethnic Group ◽  
Increased Risk

BackgroundStudies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals.AimsTo investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes.MethodData were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week.ResultsThere were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient –21.1 days, 95% CI –24.6 to –17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week.ConclusionsBeing admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a different clinical population to those admitted during the week. This is an important consideration if mental healthcare services are to be implemented across a 7-day week.

scholarly journals Trauma-informed mental healthcare in the UK: what is it and how can we further its development?

2016 ◽  
Vol 21 (3) ◽  
pp. 174-192 ◽  
Author(s):  
Angela Sweeney ◽  
Sarah Clement ◽  
Beth Filson ◽  
Angela Kennedy
Keyword(s):  
Mental Health ◽  
Mental Healthcare ◽  
Trauma Survivors ◽  
Health Service Provision ◽  
Content Type ◽  
The Usa ◽  
Trauma Informed ◽  
Barriers To Implementation ◽  
The Uk ◽  
Mental Health Service Provision

Purpose The purpose of this paper is to describe and explain trauma-informed approaches (TIAs) to mental health. It outlines evidence on the link between trauma and mental health, explains the principles of TIAs and their application in mental health and explores the extent to which TIAs are impacting in the UK. Design/methodology/approach The approach is a conceptual account of TIAs including a consideration of why they are important, what they are and how they can become more prevalent in the UK. This is supported by a narrative overview of literature on effectiveness and a scoping of the spread of TIAs in the UK. Findings There is strong and growing evidence of a link between trauma and mental health, as well as evidence that the current mental health system can retraumatise trauma survivors. There is also emerging evidence that trauma-informed systems are effective and can benefit staff and trauma survivors. Whilst TIAs are spreading beyond the USA where they developed, they have made little impact in the UK. The reasons for this are explored and ways of overcoming barriers to implementation discussed. Originality/value This paper – authored by trauma survivors and staff – describes an innovative approach to mental health service provision that, it is argued, could have immense benefits for staff and service users alike.

SECUre: a multicentre survey of the safety of emergency care in UK emergency departments

2021 ◽  
pp. emermed-2019-208965
Author(s):  
Lynsey Flowerdew ◽  
Michelle Tipping
Keyword(s):  
Safety Culture ◽  
Good Practice ◽  
National Level ◽  
Mental Healthcare ◽  
Negative Effects ◽  
Cronbach’S Alpha ◽  
Frontline Staff ◽  
Cronbach's Alpha ◽  
The Usa ◽  
The Uk

IntroductionAccording to safety theory, frontline staff are often best informed to identify problems that threaten safety in their workplace. Surveying emergency department (ED) staff is a straightforward method for investigating risks, identifying solutions and evaluating interventions. This study’s aim was to validate an ED safety questionnaire specifically for use in the UK and provide an overview of safety culture and risks.MethodsAn ED safety questionnaire developed in the USA was modified then validated using 33 RCEM (Royal College of Emergency Medicine) patient safety leads (calculating content validity index). The resulting 39 multiple-choice questionnaire was used in a multicentre survey. 110 participants were randomly selected from each site. A minimum 40% response rate per site reduced non-response bias. Cronbach’s alpha was calculated across five categories as an estimate of reliability. Simple descriptive statistics were used to identify risks or good practice. χ2 test compared individual sites’ results with national results to highlight outlier questions (ie, the department’s strengths and weaknesses). χ2 was also used to identify significant differences between responses from nurses and doctors.Results1060 participants were recruited across 18 sites. Cronbach’s alpha was adequate (0.65 to 0.8). Analysis highlighted risks posed by interruptions, negative effects of targets, deficient mental healthcare (especially compared with critical care) and ED crowding. The study also revealed encouraging safety culture, such as effective doctor–nurse communication, and identified sites that were positive outliers overall or for specific questions. Comparing doctors and nurses’ responses suggests additional support is needed for nursing staff.ConclusionsThis study provides the first step towards assessing ED safety culture and describing risks in the UK. Identifying outlier sites provides opportunities to learn from excellence. Repeat application of the survey will enable monitoring of safety interventions on a local and national level.

An early mainstream economist from Hungary: István Varga (1897–1962)

2003 ◽  
Vol 53 (2) ◽  
pp. 195-213 ◽  
Author(s):  
K. Majoros
Keyword(s):  
Austrian Economic ◽  
National Income ◽  
Anglo Saxon ◽  
Turbulent Times ◽  
The Usa ◽  
New Ideas ◽  
Modern Economic ◽  
The Uk ◽  
Economic Thinking ◽  
Lasting Influence

The study introduces a Hungarian economic thinker, István Varga*, whose valuable activity has remained unexplored up to now. He became an economic thinker during the 1920s, in a country that had not long before become independent of Austria. The role played by Austria in the modern economic thinking of that time was a form of competition with the thought adhered to by the UK and the USA. Hungarian economists mainly interpreted and commented on German and Austrian theories, reasons for this being that, for example, the majority of Hungarian economists had studied at German and Austrian universities, while at Hungarian universities principally German and Austrian economic theories were taught. István Varga was familiar not only with contemporary German economics but with the new ideas of Anglo-Saxon economics as well — and he introduced these ideas into Hungarian economic thinking. He lived and worked in turbulent times, and historians have only been able to appreciate his activity in a limited manner. The work of this excellent economist has all but been forgotten, although he was of international stature. After a brief summary of Varga’s profile the study will demonstrate the lasting influence he has had in four areas — namely, business cycle research and national income estimations, the 1946 Hungarian stabilisation program, corporate profit, and consumption economics — and will go on to summarise his most important achievements.

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