Use of Therapeutic Milieu Interventions in a Psychiatric Setting

Belsiyal, C Xavier; Rentala, Sreevani; Das, Anindya

doi:10.4103/jehp.jehp_1501_21

Cited by 13 publications

(6 citation statements)

References 27 publications

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“…Clinical staff were found to play a critical role in the formation of patient treatment experiences and in the creation of the ward milieu. As with previous literature [ 25 , 53 , 61 , 71 ], where patients feel seen as an individual—“more than just anorexic”—they were more likely to engage in recovery-orientated behaviours [ 65 , 70 ]. Furthermore, the ability of staff to “hold hope” [ 23 ] for a patient’s recovery appeared to strengthen participant motivation and connection to a sense of self or identity beyond their eating disorder.…”

Section: Discussionsupporting

confidence: 77%

“…Explicitly acknowledging conflicts—where clinically relevant—may allow healthcare providers to provide patients with appropriate and timely information regarding treatment decisions. For example, the provision of a clear and individualised treatment rationale—that includes the persons’ own goals along with treatment non-negotiables [ 73 ]—maximises client autonomy in the face of a dominant medical discourse [ 26 , 70 , 71 , 74 , 75 ].…”

Section: Discussionmentioning

confidence: 99%

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A systematic review of people’s lived experiences of inpatient treatment for anorexia nervosa: living in a “bubble”

et al. 2023

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Background Treatment for anorexia nervosa (AN) is typically delivered on a continuum of care, starting with outpatient treatment, and moving onto intensive outpatient, day or residential treatment and/or inpatient hospitalisation. However, minimal attention has been afforded to the lived experiences of persons undergoing inpatient treatment for AN. In particular, qualitative literature pertaining to the lived experiences of specialist inpatient or residential treatment of AN remains fragmented and incomplete. The aim of this review was to synthesise current literature exploring patients’ lived experiences of residential and inpatient treatment for AN within eating disorder-specific treatment services. Methods Five databases were searched and a qualitative thematic systematic review and meta-synthesis of 11 studies were conducted. Results Eleven studies of 159 participants were included. Four meta-themes were constructed from the data: (1) a medical discourse—“I don’t think it’s individualised here”; (2) restrictive practice—living in a “bubble”; (3) myself, others and “a similar demon”; and (4) I am “not just another anorexic”. The data also revealed two cross-cutting themes: (1) more than a single experience; and (2) meaning making and identity. Conclusions These findings highlight the complex and multifaceted nature of the inpatient treatment experience as well as the inherent conflicts in balancing the necessity of medical and psychological intervention with person-centred treatment approaches in the treatment of AN.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

A systematic review of people’s lived experiences of inpatient treatment for anorexia nervosa: living in a “bubble”

et al. 2023

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“…Researchers have developed ‘milieu therapy’ as a means to enhance patient safety outcomes and establish a secure therapeutic environment (Belsiyal et al, 2022; Lee et al, 2021). The primary objective of milieu therapy (MT) is to regulate the environment of the psychiatric ward, creating a structured and secure space that resembles a home.…”

Section: Introductionmentioning

confidence: 99%

“…Such interactions can have a significant impact on a patient's clinical progress. The presence of MHNs, therapists, and other members in socializing patients helps to create a safe and non‐threatening milieu (Belsiyal et al, 2022). Although milieu therapy (MT) offers numerous benefits, certain caregivers, including nurses and therapists, have raised concerns about its practice.…”

Section: Introductionmentioning

confidence: 99%

Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed‐methods study

Maddineshat,

Khodaveisi,

Kamyari

et al. 2023

Psychiatric Ment Health Nurs

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IntroductionPrevious research has indicated that community‐based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards.AimThis study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran.MethodAn explanatory mixed‐methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi‐structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis.ResultsThe perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including ‘Hyper‐vigilance to safety and security environment’, ‘Therapeutic communication gap’, ‘Nurse burnout’, ‘Staff safety and security need’ and ‘Environmental safety hazards’.DiscussionMHNs employ a hyper‐vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance.Implications for mental health nursingAccording to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards.

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“…It is a healing culture rich in therapeutic interpersonal relationships and cooperative attentiveness to patients. In addition, its physical features are soothing and provide for optimum safety and comfort (Belsiyal et al , 2022).…”

Section: Introductionmentioning

confidence: 99%

Extraction of effective cycles on reducing patients’ depression in the design of treatment spaces

Faghiholislam,

Azemati,

Keshmiri

et al. 2023

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Purpose The most common reaction to an acute physical illness is anxiety, which may be followed by depression. In patients with chronic diseases, the prevalence of anxiety disorders and depression is almost twice as high as in other diseases. This study aims to extract prominent components in the design of treatment spaces on reducing hospitalized patients’ depression from both experts and patients/users’ point of views. A final model is also presented based on the findings. Design/methodology/approach This research used an exploratory mixed method. The effective components were extracted through the administration of two Likert-scale researcher-made questionnaires in two phases. Q factor analysis was conducted to reach the components. A total of 205 patients were admitted to Namazi Hospital in Shiraz, and 20 architecture and psychology experts participated in the survey. Final modeling of the data was done through path analysis. Findings Six factors were found to be effective by experts in reducing depression in therapeutic spaces: nature-oriented space, targeted social space, diverse space, visual comfort, logical process and safe space. On the part of patients, seven components were deemed to be effective: visual perception, naturalism, functionalism, physical security, logical process, psychological safety and diversity. Also, four main cycles were extracted from the final model with the direct effect of diversity and the other five cycles were mediated by naturalism. Research limitations/implications A total of 15 interviews with architects and psychologists, who were available at the time of the study, were conducted in January 2018. The only general question during interviews was “In your opinion, what factors are effective in reducing the level of depression of patients in the design of treatment spaces?” This may have limited the range of factors that could be surveyed in the study. After collecting the effective factors from the aforementioned expert’s points of view, the questionnaire of experts was designed (Appendix). The expert questionnaires were distributed and edited in two stages in January 2019 among 20 architect experts who were available at the time of the study. The one-year interval between designing and administering the questionnaires occurred because of the limitations posed by the COVID-19 pandemic situation. However, the interval did not pose methodological obstacles for the study. Originality/value Evidence-based investigation of the effectiveness of proper design components of therapeutic spaces in reducing the symptoms of patients with chronic secondary depression has received little attention in the literature. Using a “conceptual model,” the present study brought the issue into its focus so as to find effective components in the design of treatment spaces that can alleviate depression symptoms in chronically hospitalized patients.

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Use of Therapeutic Milieu Interventions in a Psychiatric Setting

Cited by 13 publications

References 27 publications

A systematic review of people’s lived experiences of inpatient treatment for anorexia nervosa: living in a “bubble”

A systematic review of people’s lived experiences of inpatient treatment for anorexia nervosa: living in a “bubble”

Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed‐methods study

Extraction of effective cycles on reducing patients’ depression in the design of treatment spaces

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