Editorial: Redefining acute psychiatric care: strategies for improved inpatient experiences, vol II
Year: 2026
Type: editorial
Abstract: documented aggressive incident, and a third of these had three or more. After adjustment for withdrawal severity, three factors were independently associated with aggression: shorter sleep, higher nurse-rated suicide risk, and lower haemoglobin, even within the normal range. Explained variance was modest, but these markers are cheap, routine and potentially modifiable.Cossu et al. address patients' legal rights and the ethics of coercion directly, in the context of Article 12 of the UN Convention on the Rights of Persons with Disabilities (5). Rather than asking whether involuntary treatment is ever justified, they propose treating each instance as a sentinel event. Each would be reported, examined by root cause analysis with service users and families, and followed by an action plan. The model locates the drivers of coercion in resources, training and power asymmetries, not solely in the patient's symptoms.The ward environment is one such driver, and it bears directly on restraint. Liu, Saito and Linder used a natural experiment: renovations closed the outdoor areas of two New York inpatient units for several months in 2024 (6). On the general adult unit, the loss of outdoor access coincided with more intramuscular PRN orders, seclusion or restraint, and constant observation. On the geriatric unit, only oral PRN use increased. Although confounding cannot be excluded, outdoor space appears to be a de-escalation resource, not an amenity.gardening and outdoor activity on psychiatric wards (7). The five inpatient studies are mostly small, uncontrolled and focused on depression; they show short-term mood gains and suggest meaning, agency, belonging and calm as mechanisms. Adverse events were never systematically recorded, so powered randomised trials with safety monitoring are needed.Whether the hospital is a place where patients feel well cared for is a question only patients can answer. Cuevas-Esteban et al. applied Patient Journey Mapping to a 14-bed unit near Barcelona that uses Safewards and opens its doors six hours a day; 60% of participants were involuntarily admitted (8). Focus groups (n = 18) and ratings (n = 32) identified emergency waiting and group activities as "moments of pain". Medical visits, door openings and discharge were high points.Patients objected less to the duration of waiting than to insufficient/inconsistent information and public, communal nature of medication administration routines, both remediable at low cost.In a Málaga case-control study of 196 episodes, García-Illanes et al. combined seven variables into a points-based index for 30-day readmission: previous admissions, personality disorder, social risk, emergency attendance in the prior year, legal capacity restriction, aggression towards others at admission, and being married or widowed (9). The index discriminated moderately well (AUC 0.76; optimism-corrected 0.73). Its three risk levels can guide the intensity of post-discharge follow-up, pending external validation. Second, the outcomes this Topic set out to capture, psychosocial functioning and personal recovery after discharge, are still rarely measured. Third, the perspectives of patients, families and staff need to be brought into the same study designs. Overall, acute psychiatric care should be judged not only by its safety and efficiency, but also by its respect for autonomy and dignity and the quality of the inpatient experience.
Source: Frontiers in Psychiatry
Authors: Alfonso Ceccherini-Nelli, Stefano Barlati
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223785339