Using daily objects as material primes of valorisation and control in psychiatric facilities

As part of the built environment objects and interior design features can affect thoughts, emotions and behaviour in various ways. Referring to the concept of material and conceptual priming (Kay et al., 2004; Berger & Fitzsimons, 2008), these objects can provoke associations and by that subconsciously activate mental concepts which influence emotional states, judgements and subsequent behaviours. In many healthcare facilities, the formal-aesthetic design of the built environment visually conveys the concept of institutionalisation through clinical and sterile styles, impersonal and standardised configurations and a lack of individualisation. This applies in particular to the setting of psychiatric facilities in which from a clinical point of view sterile and impersonal aesthetics are not required and might even be detrimental to the therapeutic processes. However, there is reason to believe that the use of everyday objects can support therapeutic processes and thus be seen as an element of psychosocially supportive design (Ulrich, 1997) in two ways. Firstly, everyday objects derived from domestic contexts refer to aesthetics that are contrary to the concept of institutionalisation. Instead by communicating features of comfort and subtle luxury they might activate the mental concept of valorisation which can be seen as an important resource in therapeutic settings that strengthens commitment and trusts. Secondly, offering choice of a variety of everyday objects in psychiatric settings enables patients to exert control in a context that otherwise is characterised by total loss of control. This increased sense of control is an important part of Antonovsky's sense of coherence (1979) and a valuable asset for recovery and empowerment of psychiatric patients.

Smoke-Free Hospital Grounds

Smoke-free campus policies at inpatient health facilities are most effective when situated within comprehensive smoking cessation programs that include cessation support for staff and patients and effective communications and signage for staff, patients, and visitors. Canadian jurisdictions such as Ontario, New Brunswick, Prince Edward Island, Alberta, British Columbia, and Northwest Territories have provincial smoke-free legislation that applies to the grounds of health facilities. This approach permits public health inspectors and peace officers to enforce the smoke-free grounds rules with the option of issuing fines to individuals or hospital corporations for non-compliance. There is very little existing evidence on the effectiveness of issuing fines as a means of enforcing smoke-free policies. There can be unique considerations associated with implementing smoke-free policies in inpatient psychiatric facilities or units, given the relationship between mental health and substance use issues and tobacco use. Evidence shows that smoke-free policies are feasible and result in positive health outcomes in psychiatric facilities or units. Staff may require additional education and training in smoking cessation and tools to support productive conversations with patients, visitors, or colleagues who are not in compliance with smoke-free policies. Examples of tools and communications materials used in other jurisdictions are provided in Appendix 1.

Limiting transmission of COVID-19 in an inpatient psychiatric hospital using a special care unit as a behavioral health model - Michigan, March 1-August 31, 2020

Approximately 53,000 patients/year are admitted to psychiatric hospitals in Michigan and treatment typically involves social gatherings and group therapies (SAMHSA 2017; Michigan DHS 2019). Often psychiatric inpatients are in close proximity placing them at high risk of infection and have comorbid medical conditions that predispose them to severe COVID-19 consequences. In March 2020, Pine Rest Christian Mental Health Services, Grand Rapids, MI initiated protocols and precautions to mitigate the spread of COVID-19 between patients and health care personnel (HCP) based on emerging CDC guidelines. Multiple strategies [COVID-19 testing, masking of patients and HCP, restricting visitors, and creation of Special Care Unit (SCU) with negative pressure] were effectively implemented and limited transmission of COVID-19 within Pine Rest. Admission to the SCU totaled 25 adults (three Pine Rest patients who tested positive during or after admission, and 22 COVID-19 positive patients who were transferred from other facilities). Average age of SCU inpatients was 38.5 ± 16.6 years with the majority being male. Average hospitalization was 9 ± 4 days. Among the 21 COVID-19 positive HCP, 15 [71%] provided direct clinical care on various units, zero provided care on the SCU, and six had roles with no direct patient care. Average age among COVID-19 positive HCP providing direct patient care[n = 15] was 29.5 ± 13.5 years, majority were female, and 3 [20%] were admitted to local medical hospital for treatment. This report demonstrates that quality behavioral health care can be safely provided at inpatient psychiatric facilities and serve as a guideline that other psychiatric facilities can follow to decrease transmission in future epidemics.

Effects of the CMS’ Public Reporting Program for Inpatient Psychiatric Facilities on Targeted and Nontargeted Safety: Differences Between For-Profits and Nonprofits

The Centers for Medicare and Medicaid Services implemented the Inpatient Psychiatric Facility Quality Reporting Program in 2012, which publicly reports facilities’ performance on restraint and seclusion (R-S) measures. Using data from Massachusetts, we examined whether nonprofits and for-profits responded differently to the program on targeted indicators, and if the program had a differential spillover effect on nontargeted indicators of quality by ownership. Episodes of R-S (targeted), complaints (nontargeted), and discharges were obtained for 2008-2017 through public records requests to the Commonwealth of Massachusetts. Using difference-in-differences estimators, we found no differential changes in R-S between for-profits and nonprofits. However, for-profits had larger increases in overall complaints, safety-related complaints, abuse-related complaints, and R-S-related complaints compared with nonprofits. This is the first study to examine the effects of a national public reporting program among psychiatric facilities on nontargeted measures. Researchers and policymakers should further scrutinize intended and unintended consequences of performance-reporting programs.

Hospital-wide SARS-CoV-2 antibody screening of staff in a university psychiatric centre in Belgium

In this first serosurvey among psychiatric healthcare providers, only 3.2% of a sample of 431 staff members of a Belgian University Psychiatric Centre, screened 3–17 June 2020, had SARS-CoV-2 immunoglobulin G antibodies, which is considerably lower compared with both the general population and other healthcare workers in Belgium. The low seroprevalence was unexpected, given the limited availability of personal protective equipment and the high amount of COVID-19 symptoms reported by staff members. Importantly, exposure at home predicted the presence of antibodies, but exposure at work did not. Measures to prevent transmission from staff to patients are warranted in psychiatric facilities.