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A Randomized Study Comparing the Treatment Environment in Alternative and Hospital-Based Acute Psychiatric Care

Dr. Hawthorne, Dr. Folsom, and Dr. Lohr are affiliated with the Department of Psychiatry, University of California, San Diego. Dr. Hawthorne is also with Community Research Foundation, San Diego, with which Dr. Green is affiliated. Send correspondence to Dr. Hawthorne at Community Research Foundation, 1202 Morena Blvd., Suite 300, San Diego, CA 92110 (e-mail: hobie{at}comresearch.org).

OBJECTIVE: Programs that offer alternatives to hospital-based acute psychiatric care have reported promising results of lower costs, equivalent or superior outcomes, and greater patient satisfaction. This study supplements previous research that compared the outcomes, satisfaction, and cost of hospital-based care and one such alternative program, short-term acute residential treatment (START), with an analysis of patient and staff perceptions of the treatment environments. METHODS: Patients who participated were all veterans and were randomly assigned to receive treatment in a hospital psychiatric unit (N=45) or in START (N=48). Both groups completed the Ward Atmosphere Scale (WAS), a standardized measure of treatment environment, at the time of discharge. During the study, staff members from both types of programs also completed the WAS (15 hospital staff and 75 START staff). RESULTS: Both patients and staff rated the START environment more favorably than the hospital environment on five of ten WAS subscales. No differences were found in congruence between staff and participants' scores at START or the hospital. WAS profiles for patients and staff from the hospital closely matched published national norms for hospitals, whereas WAS profiles for patients and staff from START more closely resembled treatment environments recommended for the most disturbed patients (lower levels of anger and aggression and higher levels of support, problem orientation, and order and organization). CONCLUSIONS: The more favorable ratings of the treatment environment at START in this study are consistent with previously published findings demonstrating the viability of the START model as an alternative to hospital-based acute psychiatric care.

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