Sweeney Angela, Fahmy Sarah, Nolan Fiona, Morant Nicola, Fox Zoe, Lloyd-Evans Brynmor, Osborn David, Burgess Emma, Gilburt Helen, McCabe Rosemarie, Slade Mike, Johnson Sonia
Division of Psychiatry, UCL, London, United Kingdom.
Centre for Outcomes Research and Effectiveness (CORE), UCL, London, United Kingdom; Camden and Islington NHS Foundation Trust, London, United Kingdom.
PLoS One. 2014 Jul 10;9(7):e100153. doi: 10.1371/journal.pone.0100153. eCollection 2014.
Poor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses.
Mixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically.
We found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy.
We found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed.
精神科住院病房中经常出现服务对象体验不佳的情况。危机之家是一种替代选择，但相关证据有限。本文调查了急性病房和危机之家中的治疗联盟，探讨更强的治疗联盟在多大程度上可能是危机之家服务对象满意度更高的基础。
采用了混合方法。在定量部分，108名危机之家的服务对象和247名急性病房的服务对象对满意度、治疗关系、非正式同伴支持、康复情况以及住院期间经历的负面事件进行了测评。进行线性回归以估计服务环境与各项测评之间的关联，并对与满意度相关的因素进行建模。对每个环境中的服务对象和工作人员进行了探索治疗联盟的定性访谈，并进行了主题分析。
我们发现，危机之家中的治疗联盟、服务对象满意度和非正式同伴支持比急性病房更高，而自我评定的康复情况和负面事件数量则更低。调整后的多变量分析表明，治疗关系、非正式同伴支持以及与工作人员相关的负面经历可能是危机之家满意度更高的重要因素。定性结果表明，影响治疗联盟的因素包括服务对象对工作人员善良和同理心等基本人性品质的认知，以及在服务层面上自由和自主权的丧失程度。
我们发现，与急性病房相比，服务对象在危机之家中体验到更好的治疗关系和更高的满意度，尽管我们不能排除服务对象特征差异对此有影响的可能性。这一发现为扩大危机之家的提供范围提供了一些支持。需要进一步研究来调查为什么急性病房的服务对象会感受到病房工作人员缺乏同情心和人性，以及如何改变这种情况。
