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Does major renovation of inpatient units in psychiatry improve treatment outcomes?

WSW_October-30-2013

Most of us probably assume that improving the physical characteristics of a treatment environment in an inpatient unit should help increase the chance of treatment success. However, there is little information available showing that such renovations of a psychiatry unit improves treatment.

CAMH Scientist Karen Urbanoski and her colleagues addressed this question by taking advantage of the construction of a new CAMH inpatient unit for the treatment of mood and anxiety disorders. Prior to the redesign, the unit consisted of a central nursing station, lounge area, shared bathrooms, and two-person rooms.  After construction of the units, clients had the option of either staying in the original unit, or the new unit that was much more client-centred with private rooms with ensuite bathrooms and showers, a kitchen, private visitation room, and nursing stations on only two of the four floors.

As reported in Psychiatric Services, 290 patients were surveyed. Some stayed in the old unit before the redesign, and others were inpatients on the new unit.

The investigators found that after the redesign, patients had improved treatment satisfaction and greater quality of life, which was associated with the new inpatient unit “atmosphere.” However, an assessment of patients’ “global functioning” did not show any association with changes in the unit’s atmosphere. Global functioning measures a person’s ability to function in school, work and with other daily activities.

The researchers suggest that global functioning scores might not have improved after the renovation because scores of patients recruited after the design were higher at admission than scores of those recruited before the redesign—and there was little room for further improvement of scores.

Dr. Urbanoski emphasizes that her study is only preliminary, but it hopefully will lead to other studies aimed at determining whether major, and costly, renovations of inpatient units in psychiatry improve treatment.

4 Comments Post a comment
  1. annick #

    Let’s us all live in squalor then !

    October 31, 2013
  2. Katherine #

    While it may not improve outcomes, it certainly decreased my shame about being in hospital and made me feel like a valued human being to be able to be in one of CAMH’s new building where persons receiving treatment were able to be more autonomous and have the privacy to reflect and work on recovery.

    November 20, 2013
    • Karen Urbanoski #

      This is a great comment, Katherine. Our study found that the people who stayed on the units were much more satisfied with the new space and reported an improved atmosphere. As you have pointed out, that’s important – regardless of what the findings say about clinical improvement. Also, it’s just one study, and there’s a lot more that could be looked at on this subject. Thanks for sharing your experience!

      November 22, 2013
  3. David Goldbloom #

    This study does not lead to the conclusion that people should live in squalor! It is a challenge to find the right measures to capture the impact of more decent and respectful inpatient environments, and the broader the measure the more likely it will reflect multiple influences on its final score. However, an improvement in treatment satisfaction and quality of life should be encouraging in our efforts to redevelop CAMH. Anyone who has seen the older facilities at CAMH – narrow hallways, tiny rooms, shared bathrooms, and an abundance of cinder block and concrete – as well as the newer ones needs no study results to determine their personal preference. This study includes the “more work is needed” comment ubiquitous and true in all research. But better facilities are also needed.

    November 21, 2013

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