Establishing therapeutic programs in the public sector psychiatric hospital: rethinking the possibilities and priorities.

In public sector hospitals, many patient therapeutic needs are easily identified, but multiple variables present in the system obscure the planning and implementation to meet these needs. Contextual variables that hinder program development include the physical environment; patient population; lack of guiding treatment philosophy; inconsistent approach; staff limitations; resistance to change; morale issues; and bureaucratic impasses. Assessment of the system culture is essential; determining the possibilities and priorities of the system will aid in designing and implementing projects or programs.