Treatment regimes in a psychiatric hospital and apparent contradictions: Report from field work in a lock‐up ward illustrated with a constructed case

Abstract

The medical approach dominates in Norwegian psychiatry, but mental health nurses and other ward staff hold that milieu therapy constitutes an additional and important treatment approach for psychiatric patients. In this study, we wanted to explore these approaches as they are implemented in inpatient treatment. We conducted a 9-month ethnographic study in two lock-up psychiatric wards in a Norwegian psychiatric hospital. In this article, we present a constructed case, Mary, to illustrate the voices, experiences, and perspectives of patients and staff as observed primarily in the patients' smoking room, the corridor, and the staffroom. From the perspective of staff, we identified at least two professional perspectives concerning patients' daily life: a strong medical-psychiatric view and a weaker therapeutic milieu, which seemed difficult to implement. When considering the view of people in care, we observed that patients' experiences and points of view occurred and remained to a large degree in their smoking room, and patients seemed to have little impact on their own treatment programmes. This stands in sharp contrast to patients' legal rights to participate in any important decisions regarding their treatment and to the espoused person-centred orientation in health care today.