Good organisation and routines can lead to calmer psychiatric wards, but wards with too many unqualified and temporary staff, or that are badly organised or have poor routine have the opposite effect, according to a study.

Dr Chris Papadopoulos, senior lecturer in public health at the University of Bedfordshire and part of the Institute for Health Research, has been working on a five-year program of research - led by Professor Len Bowers at Kings College London - into how acute psychiatric wards can provide better care for patients with schizophrenia and psychosis, for example, and aid staff who treat them.

The findings look at correlations between a range of patient, staff and ward characteristics and levels of conflict – incidents that affect whether a patient escapes or is violent, for example – and containment – methods used to manage someone who is violent, for instance, such as extra medicines or restraint.

The researchers looked at patient and staff activity, in particular conflict and containment incidents, and also how the wards were managed in 136 wards in England between 2004 and 2005.

They found:
• Low conflict, high containment wards were predominately larger and featured fewer patients with schizophrenia and those admitted for the risk they pose to others
• High conflict, low containment wards had a greater number of male staff and were not based in quality premises
• High conflict, high containment wards had high levels of unqualified and temporary staff
• Low conflict, low containment wards were different in very specific ways including being based in nicer premises, better ward structure and organisation, and fewer patient beds.

The results, published in the journal Psychiatric Services, are expected to influence policy and good practice and make psychiatric wards safer and more therapeutic environments.

Dr Papadopoulos said: “Conflict and containment events take their toll on patients and staff and are also expensive for the NHS so we have been looking at how we can, most importantly, improve patient care, but also save money.

“There are very clear implications that are important for patients and staff. If we can illuminate which wards are more likely to be therapeutic we can create more wards which benefit both patients and staff. We are beginning to know the way forward and that’s a crucial step.”