Feasibility of a ward-based psychological intervention to improve staff and patient relationships in psychiatric rehabilitation settings.

OBJECTIVES: Recent inquiries highlight the anti-therapeutic nature of inpatient psychiatric care. We aim to assess the feasibility and potential efficacy of a ward-based psychological intervention to improve staff-patient relationships in psychiatric rehabilitation settings.

METHODS: A single-blind cluster randomized design compared the intervention with treatment as usual (TAU) on measures of relationships, staff well-being, and patient functioning. Assessments were carried out at baseline and at 6 months.

RESULTS: Fifty-one patients and 85 staff were recruited across 10 wards. Fifteen patients and 11 staff were lost to follow-up, with primary reason being ward discharge. Uptake to the intervention was variable but on average lower than anticipated (mean number of sessions 3.5, range 0-11). Despite this lower than anticipated uptake, compared with TAU, patients in the intervention arm felt significantly less criticized by their key workers and reported improvements in ward atmosphere. Staff in the intervention arm also reported significantly lower levels of depersonalization post-intervention. Although trend level data favoured the intervention group, in this relatively small feasibility study, we were not able to demonstrate statistically significant differences between the groups in terms of staff perceptions of relationships, staff stress, and longer-term patient outcomes.

CONCLUSIONS: This psychologically informed ward-based intervention shows potential in improving relationships, although findings and feasibility may be enhanced if further measures are put into place to ensure that all members of the team attend intervention sessions on a more frequent basis. Loss at follow-up due to discharge also needs to be factored into future power calculations.

PRACTITIONER POINTS: It is feasible to implement and trial a ward-based psychological intervention (team-based formulation) in long-stay psychiatric settings using a cluster randomized design. Developing psychological formulations with frontline ward staff around patients' needs has the potential to improve staff-patient relationships. The small sample size and loss of data at follow-up may have limited the power of the study to detect the full range of treatment effects. Larger trials are needed to assess the reliability and generalizability of our findings across different wards.