Ward Milieu Research Articles

Aggressive behavior and its associated factors among persons with mental illness: An observational study.

Aggressive behavior of psychiatric inpatients causes severe complications during treatment; nursing staff needs to understand the factors associated with aggression in inpatient units to prevent aggression. This study aimed to examine the level of aggression and its associated factors. A descriptive observational design was conducted among aggressive patients. An aggressive behavior event was observed during the aggression episode. Data were collected from 55 patients with aggressive behavior using the Staff Observation Aggression Scale-Revised (SOAS-R) and Brief Psychiatric Rating Scale (BPRS). Patient-, staff-, and ward-related factors were assessed using a structured questionnaire. About 69% of patients had a severe level of aggressive behavior. There was a significant association between gender, the severity of symptoms, staff-to-patient ratio, ward milieu, and the number of caregivers with levels of aggression. The majority of the persons with mental illness exhibited severe aggression in a psychiatric setting. Being male, the presence of psychotic symptoms, ward milieu, staff-to-patient ratio, and availability of caregivers were significantly associated with aggression. This study adds to the existing literature by focusing on managing ward-related factors (avoiding noise and overcrowding) to prevent aggressive behavior among mentally ill patients.

Interventions to reduce self-harm on in-patient wards: systematic review.

Incidents of self-harm are common on psychiatric wards. There are a wide variety of therapeutic, social and environmental interventions that have shown some promise in reducing self-harm in in-patient settings, but there is no consensus on the most appropriate means of reducing and managing self-harm during in-patient admissions. To review interventions used to reduce self-harm and suicide attempts on adolescent and adult psychiatric in-patient wards. A systematic literature search was conducted between 14 March 2019 and 25 January 2021 using PsycINFO and Medline (PROSPERO ID: CRD42019129046). A total of 23 papers were identified for full review. Interventions fell into two categories, therapeutic interventions given to individual patients and organisational interventions aimed at improving patient-staff communication and the overall ward milieu. Dialectical behaviour therapy was the most frequently implemented and effective therapeutic intervention, with seven of eight studies showing some benefit. Three of the six ward-based interventions reduced self-harm. Two studies that used a combined therapeutic and ward-based approach significantly reduced self-harm on the wards. The quality of the studies was highly variable, and some interventions were poorly described. There was no indication of harmful impact of any of the approaches reported in this review. A number of approaches show some promise in reducing self-harm, but the evidence is not strong enough to recommend any particular approach. Current evidence remains weak overall but provides a foundation for a more robust programme of research aimed at providing a more substantial evidence base for this neglected problem on wards.

Rethinking obstetric violence and the \u201cneglect of neglect\u201d: the silence of a labour ward milieu in a South African district hospital

BackgroundResearch into the mistreatment of women during childbirth has increased over recent years. Overt violence is an important focus of research, but recently there has been increasing recognition that there are other ways in which women in labour may be uncared for or even hurt. As part of a larger study focussing on staff responses to stillbirths, we wanted to gain contextual information on how high risk pregnancies are handled in general in Khayelitsha Hospital, a district hospital in an impoverished urban setting in the Western Cape Province of South Africa. This health care system experiences an immense patient load, the poverty of the community it serves, and the numerous traumas affecting both patients and staff.MethodsIn order to obtain rich exploratory data, a qualitative research methodology was used. The primary data source was observations in the labour ward, interviewing labour ward staff (doctors, nurse, and cleaners). The secondary data source was the analysis of hospital documents, specifically those related to labour ward policy.ResultsFrom our numerous observations and discussions, it is clear that no one is being overtly mistreated in this hospital and patients are medically well attended to. Although we saw no physical abuse, we noted the silence in the ward. Beside medical related interactions, we also noted that there were limited interactions between the women and the health care providers.ConclusionsSilence can be a form of neglect as it leaves the women feeling uncared for and not seen. In an overburdened health care system where both staff and patients are often overwhelmed or traumatised, silence can be a way in which a system defends itself against what it knows it cannot provide.

The nature of the therapeutic alliance between nurses and consumers with Anorexia Nervosa in the inpatient setting: Amixed-methods study.

To develop a greater understanding of the nature of the inpatient therapeutic alliance between nurses and consumers with Anorexia Nervosa (AN). Consumers with AN value interpersonal relationships with nurses, finding these relationships meaningful and therapeutic. It is established that the therapeutic alliance enhances outcomes for consumers with AN. However, establishing the therapeutic alliance in the inpatient setting is considered challenging. This study employed a two-phase mixed-method explanatory sequential design. An initial quantitative survey, phase one, was followed by the collection and analysis of qualitative data, phase two. Phase one employed validated survey instruments, measuring the perceived degree of therapeutic alliance and elements of ward milieu. Phase two involved semi-structured interviews that focused on therapeutic relationships between nurses and consumers, with specific exploration of the results from phase one. Data collection commenced May 2014 and concluded February 2015. The therapeutic alliance involved interpersonal engagement and a balanced application of authority. In a therapeutic alliance, nurses cared for consumers with interpersonal finesse, whilst maintaining clear distinction between the consumer as an individual and AN as an illness. Nurses also developed a therapeutic alliance by occupying their position of power with consistent yet individualised expectations and by maintaining appropriate professional boundaries. The therapeutic alliance between nurses and consumers with AN is not developed through negotiation of equal partners. Rather, the therapeutic alliance is dependent on nurses' capacity to maintain their position of power, whilst demonstrating their trustworthiness to the consumer. In trusting nurses, consumers felt safer in investing in a new concept of well-being. By understanding the nature of the therapeutic alliance as it is described in this study, nurses have an enhanced capacity to develop effective therapeutic alliances with consumers. A maternalistic nursing style emerged as a viable approach.

Religious Barriers to Mental Healthcare

Religious Barriers to Mental Healthcare

Implementing music therapy on an adolescent inpatient unit: a mixed-methods evaluation of acceptability, experience of participation and perceived impact.

We aimed to assess the feasibility of delivering a music therapy program on adolescent psychiatric wards. We undertook a mixed-methods evaluation of a pilot program. Various active and receptive techniques were employed in group music therapy sessions delivered as part of a structured clinical program. Data collected in interviews with participants and staff and feedback questionnaires were thematically and descriptively analysed and triangulated. Data from 62 questionnaires returned by 43 patients who took part in 16 music therapy sessions, and seven staff, evidenced strong support for music therapy. Patients typically reported experiencing sessions as relaxing, comforting, uplifting, and empowering; >90% would participate by choice and use music therapeutically in the future. Staff endorsed music therapy as valuable therapeutically, reporting that patients engaged enthusiastically and identified sessions as improving their own moods and ward milieu. Integration of music therapy in inpatient treatment of adolescents is feasible and acceptable, and is valued by staff and patients as a complement to 'talking therapies'. Participation is enjoyed and associated with outcomes including improvement in mood, expression of feelings and social engagement consistent with recovery.

Temporal Trends in Self Harm and Aggression On a Paediatric Mental Health Ward

The aim of this paper is to describe trends in aggression and self harm on a mental health inpatient unit for children and adolescents between January 2006 and August 2009. Various ward interventions and the ward milieu were evaluated as possible explanatory factors for trends. This was a retrospective study whereby incidents of aggression, self harm and seclusion were obtained from a computerized Incident Information Management System (IIMS) database. Trends in incidents were analysed using linear regression analyses. Over a 44-month period, 292 incidents of aggression and 139 incidents of self harm were reported. The use of seclusion and the number of aggressive incidents both significantly decreased over time. Trends suggested a positive relationship between the introduction of restraint training, changes in leadership and full staff complement, and a reduction in aggression and seclusion. Although the findings are limited by their retrospective nature and reliance on formal records, this study suggests that different factors can contribute to decrease the incidence of adverse events on a psychiatric ward. Future prospective research is needed to assess the effectiveness of different interventions in both the prevention and management of self harm, aggression and seclusion in child and adolescent inpatient units.

Community meetings on acute psychiatric wards: a therapeutic intervention or a meaningless exercise?

Although long a feature of inpatient mental health ward routine, community meetings have not always attracted a clear sense of purpose and value. A common complaint from patients is that community meetings are useless and have no worthwhile purpose. It was thought that staff on acute wards would benefit from having a space to think about community meetings, and a work discussion group was provided over a duration of 18 months. It was hoped that this intervention would enable facilitators to think about these meetings and about their aims and benefits. This paper presents findings from the work discussion group: staff facilitators' experience of facilitating community meetings and patients' direct feedback to facilitators about their experience of these meetings. The conclusions made are that community meetings could provide a useful forum for patients and staff if they:• are of benefit to patients• provide a forum for development of the therapeutic alliance between patients and staff• contribute towards improvement of the ward milieu• provide a forum for staff to develop therapeutic skills• provide a forum for staff to develop working relationships with colleagues and different professionals in the team.

Neuroleptic Malignant Syndrome After Exposure to Asenapine

To the Editor: Neuroleptic malignant syndrome is a serious side effect of antipsychotic medications that occurs in up to 2% of those receiving neuroleptics.1 The syndrome is characterized by hyperthermia, extreme muscle rigidity that leads to elevated creatinine phosphokinase, autonomic instability, and mental state changes characteristic of a delirium. Asenapine is a newly available second-generation antipsychotic. Described here is a patient who developed a malignant neuroleptic syndrome following exposure to asenapine.2 We believe it is the first such case described with this agent. Case report. Mr A, a 23-year-old white man, was administered asenapine 10 mg at bedtime in 2010 for a psychotic state characterized by auditory hallucinations and paranoid ideation. The auditory hallucinations were characterized by multiple voices calling him derogatory names. Prior to initiation of this treatment, the patient had received no medication. The patient was administered 3 subsequent doses without clinical improvement over the next 72 hours. On the third day of treatment, he became confused; his confusion was characterized by disorientation to time and situation that was distinct from his psychotic state. His mother reported that he appeared “feverish” due to excess sweating. He went to a general hospital emergency room, where examination revealed his temperature to be 99.8°F, with elevated blood pressure of 190/87 mm Hg, diaphoresis, elevated creatine kinase (719 IU/L), and leukocytosis characterized by a white blood cell count of 14.6 × 103/mm3. A tentative diagnosis of malignant neuroleptic syndrome was made. Because the patient was psychotic and trying to leave against medical advice, he was sedated with benzodiazepines to such a significant degree that intubation was required and then was admitted to the medical intensive care unit. Hydration, dantrolene, and bromocriptine were administered. His creatine kinase level returned to within normal limits within 36 hours, and he was extubated. After he was transferred to the inpatient psychiatric unit, his psychotic symptoms remained, but he was completely oriented and cooperated with the ward milieu. History revealed that his psychotic symptoms were gradual in onset, and a tentative diagnosis of schizophrenia (per DSM-IV criteria) was made. The above case fits with criteria for neuroleptic malignant syndrome and should remind all clinicians that all antipsychotics, whether first or second generation, have potential for this serious side effect. Clinicians utilizing asenapine must remember this potential side effect that is found in all agents in this class of drug.3

Miljøterapi som kollektivt eller individrettet fenomen? En etnografisk studie av dagliglivet i et psykiatrisk sykehus i individualismens tidsalder

The article illuminates milieu therapy as a collective and democratic tradition in the era of individualism. The article is based on a nine months ethnographic field research on daily life and milieu therapy in a psychiatric hospital. Milieu therapy is in its origin a psycho-social therapeutic tool which is based on a collective daily life, while policy documents of today are formulated in an individualistic way. In order to illuminate the tension between the collectivistic milieu therapy and individualistic considerations the article compares the tradition of «The therapeutic community» with milieu therapy of today. Milieu therapy of today can be considered individualistic. Milieu therapy efforts were addressed towards the individual patient, and not addressed towards the ward milieu as a whole. Furthermore, the ward milieu was organized for patients to take choices based on individual wishes and needs, and not for collectivistic purposes. The article discusses how the ward milieu can be organized for the purpose of considering individual patients' wishes and needs, as well as how to facilitate and utilize the possibilities of a larger psychosocial environment.

Patients' perceptions of their stay in a psychiatric seclusion area

Background: The psychological, social, and physical aspects of the ward milieu affect treatment outcomes and patient satisfaction. The primary aim of the present study was to describe and explore patients’ perceptions of their stay at a Norwegian seclusion area. The patients’ experience of having received help and support from the staff, sense of respectful treatment, information received regarding effects and side effects from medication, and feelings of security in the seclusion areas were of interest.Method: In a given period, all patients acutely admitted to a seclusion area were evaluated on a number of rating scales. Immediately after discharge they were invited to evaluate their treatment satisfaction on an eight-item VAS-scale.Results: The main finding is that the patients generally experienced the stay as positive. The three single items of support from the staff, a sense of respectful treatment, and feelings of security were assessed as positive, while the patients’ experience of having received help and information regarding medication was evaluated as neither positive nor negative.Conclusion: In general, patients experienced their stay as positive. The patients that were admitted voluntarily reported significantly better experiences with regard to the help received, support from the staff, and respectful treatment.

Epidemiology of absconding from an Iranian psychiatric centre

Absconding by psychiatric patients from acute psychiatric wards has been a significant problem for some time. This study was conducted to identify the incidence rate of absconding in a psychiatric hospital and some of the characteristics of patients who had escaped from hospital in year 2006. In this descriptive cross-sectional study, all of absconds in our centre have been registered in the period of 9 months. We assessed patients' age, gender, marital status, hospital stay, substance abuse, psychiatric diagnosis and site of absconding. A total of 43 cases of absconding have been registered in this period, attempted by 35 patients, with the incidence rate of 3% in our centre. The mean age of absconders was 31.7 years; 95.3% of absconds were made by men; 67.4% were single; 37.4% absconded through the main door; 62.8% of our absconders had bipolar mood disorder or schizophrenia; mean in hospital stay before absconding was 18.4 days; and 53.5% of absconds were attempted by substance users. Absconders utilize a significant portion of hospital resources and have an adverse effect on ward milieu. It seems that the patients who are more prone to abscond are male, young, single, addict, with the diagnosis of bipolar mood disorder or schizophrenia and patients who are admitted not long ago.

Smoking Bans on Psychiatric Units: Boundaries and Health Promotion

Back to table of contents Previous article Next article LetterFull AccessLetterVincenzo Villari M.D.Giulio Barzega M.D.Vincenzo Villari M.D.Search for more papers by this authorGiulio Barzega M.D.Search for more papers by this authorPublished Online:1 Sep 2008https://doi.org/10.1176/ps.2008.59.9.1063bAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Smoking Bans on Psychiatric Units: Boundaries and Health PromotionTo the Editor: On January 10, 2005, the Italian government implemented a law that bans smoking in all enclosed places. An emerging body of evidence shows that it is possible to introduce smoking bans in psychiatric units ( 1 , 2 ). However, many psychiatric settings in Italy lack a clear smoking policy. In this letter we describe the impact on staff and patients of a complete smoking ban that was implemented in a 14-bed psychiatric emergency service that serves primarily an inner-city population in Turin, Italy. The service admits patients from the hospital's emergency department 24 hours per day. Six months before and six months after the ban was implemented, staff members completed a brief questionnaire about their attitudes toward the desirability of the smoking ban and its perceived impact on patients' mental status and the ward milieu. In addition, objective indicators of ward disruption were measured, including rates of aggression, use of PRN medications, need for restraint, elopement, and discharge against medical advice. Chi square tests were used to evaluate the impact of the ban on objective indices of ward functioning. Charts were reviewed for 248 patients discharged from the unit during the six months before the ban and 220 patients discharged during the six months after its implementation. No significant differences in demographic or clinical characteristics were found between the two groups. Our analyses found no significant differences in objective indicators of ward disruption before and after the ban. Most of the monitored parameters of disruptive behavior remained stable; for other parameters the changes did not reach statistical significance. No changes were noted between the two periods in staff turnover or in problems related to staff illnesses or casualties. Staff members' responses to the questionnaire indicated that they initially disagreed with the new smoking policy. Such early opposition has been found in other studies ( 3 , 4 ). Spontaneous comments were generally negative, reflecting staff members' belief that patients need to smoke in order to relieve the stress and discomfort of their illness and to counter the side effects of drugs. Almost all respondents feared that the smoking ban would increase verbal and physical assaults. Staff members reported that they often used cigarettes to offer support, to manage threatening violence, and to reward appropriate behavior in difficult situations. The prospect of removing this bargaining tool and reward raised concerns that use of restrictive approaches, such as restraint, would increase. Only one respondent offered a positive comment, remarking that the patients and staff who did not smoke would appreciate a smoke-free environment. Six months after the ban was implemented, questionnaire responses and spontaneous comments indicated that many staff members had changed their minds and appreciated the new policy. Many felt that the old approach was a typically paternalistic one in which cigarettes were used like tokens to keep patients quiet and that such an approach hindered staff from developing insights about patients and good relations with them. Staff reported that the new policy helped them find alternative ways of interacting with patients. Staff noted that when they used a cigarette as a reward, patients demonstrated the desired behavior just to obtain it. With the ban in place, staff found new ways to negotiate with and empower patients. Thus the new environment was not just physically healthier but also mentally healthier.Smoking bans in institutional settings provide an opportunity for staff to work with patients on boundaries and limits. Staff helped patients manage their smoking behavior when patients were faced with the limitation imposed on their behavior by the ban. The situation provided a basis for staff to work with patients to manage other behaviors and gain insight about other limitations. In addition, helping patients understand limits is a key factor in the deescalation approach to managing psychiatric emergencies. On the basis of our experience, we conclude that smoking bans in psychiatric settings can lead to better patient care, although such bans are often difficult to implement. Before the ban, it was clear that staff gave little thought to this problem. Some of them even believed that their smoking with patients had therapeutic value ( 3 , 5 ). However, after an initial phase of opposition, both patients and staff adapted to the new policy. Acknowledgments and disclosuresThe authors report no competing interests.The authors are affiliated with the psychiatric emergency service at Giovanni Battista Hospital in Turin, Italy.

Hyperammonemia Due to Valproic Acid in the Psychiatric Setting

Hyperammonemia Due to Valproic Acid in the Psychiatric Setting

Hyperammonemia Due to Valproic Acid in the Psychiatric Setting

In 1980 Coulter and Allen (1) reported the first case of hyperammonemia, to our knowledge, with otherwise normal hepatic function tests in a child with epilepsy treated with valproic acid. Since that time, there have been several additional case reports and studies within the neurology literature that have established hyperammonemia with otherwise normal hepatic function as a potential side effect of valproic acid, especially in children and adolescents (2). Settle (3) published the first case of hyperammonemia, to our knowledge, in a psychiatric setting in 1995. Several additional cases have followed it. Unfortunately, to date, to our knowledge, there has only been one prospective study published within the psychiatric literature (4). We present here a patient’s history that illustrates how the symptoms of a psychiatric disorder might make the diagnosis of hyperammonemic encephalopathy difficult.

Best Practices: Environmental and Therapeutic Issues in Psychiatric Hospital Design: Toward Best Practices

The psychiatric hospital environment plays a significant, though often underappreciated, role in patient and staff functioning. This column reviews the literature on important environmental and therapeutic issues in psychiatric hospital design. Research findings and clinical conjecture reported over the past 50 years indicate that intervening environmentally through clinically informed, patient-centered design can improve functioning both among and between patients and staff. This column identifies specific best practice considerations and recommendations for designing inpatient psychiatric facilities and may serve as a useful planning resource to those interested in adopting a patient-centered, inclusive approach to design and treatment.

Ward atmosphere in acute psychiatric inpatient care: Differences and similarities between patient and staff perceptions

The purpose of the study was to compare patient and staff perceptions of the social climate in apsychiatric department, in order to investigate to what extent the two groups agree in their viewof the ward milieu. Ninety-six patients and 66 staff members answered the Ward AtmosphereScale (WAS) questionnaire, comprising a 100-item "real-form" concerning the ward atmosphereas it is actually perceived and a 100-item "ideal-form" concerning the atmosphere in animagined "best of all" ward. Staff scores were significantly higher than patient scores on theWAS-R subscales Involvement, Spontaneity, Practical orientation, Personal problems orientationand Program clarity, and on the WAS-I subscales Spontaneity, Practical orientation, andAnger and aggression. Patient scores were significantly higher than staff scores on the WAS-Rsubscale Staff control and on the WAS-I subscales Support, Autonomy and Staff control. At thesame time, the findings showed that the WAS-profiles of the two groups were highly concordantregarding both "realities" and "ideals". In conclusion, patients and staff do to some extent differin their perception of the social climate in the ward. However, the differences seem to reflectnuances in views rather than fundamental differences in opinion. From an overall point of view,the findings suggest a basic agreement between patients and staff regarding the valuation of thetreatment environment as well as the general preferences concerning the ward milieu.

Acute wards: problems and solutions

This paper describes rehabilitation principles and some specialised practice that could usefully inform the provision of acute in-patient care. A low secure rehabilitation setting is described using a method of case formulation to embed an envelope of care around an individual patient within a therapeutic ward milieu. This increases the collaboration and transparency around individual care planning and the capacity for self-reflection within the multi-disciplinary team, in a manner that may be applicable to other in-patient settings.

A review of suicide within the State Hospital, Carstairs 1972-1996.

This retrospective case note review describes the demographic, forensic and psychiatric backgrounds of 14 in-patient suicides in a maximum secure hospital. The majority were schizophrenic with chronic treatment-resistant illnesses, who had committed proportionally more violent offences, had a history of serious self-injury but no recognized clear depressive episodes. This profile is markedly different from that reported in general psychiatric in-patients, out-patients and suicides in prison, but is similar to that described in a maximum secure hospital in the United States and in long-stay patients in Canada. Many of the patients had continued to experience significantly subjective distress over many years. The clinical relevance of this series is discussed in the context of the assessment of suicidal intent in psychotic patients. We speculate that the decrease in in-patient suicides in the State Hospital may be due to a less restrictive ward milieu, increased staff/patient ratios, or the introduction of Clozapine.

Linking discharged patients with peers in the community.

Back to table of contents Previous article Next article Frontline ReportsFull AccessLinking Discharged Patients With Peers in the CommunityRobert W. Bjorklund, A.C.S.W., M.P.A.Robert W. BjorklundSearch for more papers by this author, A.C.S.W., M.P.A.Published Online:1 Oct 2000https://doi.org/10.1176/appi.ps.51.10.1316AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Few would disagree that peer support for people with severe and persistent mental illness strengthens the likelihood of their successful reintegration into the community, but little has been done to formally develop a consumer-centered approach within the discharge planning process at state hospitals. Eastern State Hospital in Medical Lake, Washington, has set up an innovative social network intervention that links patients who are being discharged from the hospital with peers in the community. Besides providing social support and friendship, a key role of peers is to help discharged patients consistently attend their weekly case management appointments at the local community mental health center.The hospital's social work department began the intervention by selecting inpatients with an axis I diagnosis who met discharge criteria and expressed willingness to be matched with a peer. These patients were then referred by their social worker to a discharge readiness group to prepare them for reentry into the community. Participation in the group and in the peer support intervention, which was part of the group's focus, was voluntary.A pool of potential peers was selected from three local resources: a psychosocial rehabilitation clubhouse, an Alliance for the Mentally Ill chapter, and a Depressive and Manic-Depressive Association chapter. During patients' participation in the discharge readiness group, a profile of each patient's preferences about a peer's age, interests, and similar factors was compiled. This information was provided to the patient's case manager at the community mental health center, who then selected the peer who best matched the patient's interests and commonalities. At the patient's discharge, case managers met with the patient and facilitated the initial meeting with the peer.Thirty-five patients who were linked with peers in the community were followed up for one month after hospital discharge. Twenty-three of these patients consistently attended their weekly case management appointments, a 66 percent compliance rate. Aftercare service records indicated that discharged patients who did not participate in the peer support intervention attended only one-third of their postdischarge appointments. A 66 percent attendance rate for discharged patients is encouraging when compared with national study reports that only 30 percent of patients keep their first postdischarge appointment.The majority of patients who received this intervention were enrolled in clubhouse services, which made outreach by peers easier, and most peer relationships were ultimately strengthened. The peer-linkage approach proved cost-effective and easy to implement. Initial observations were that it works best as a component of the discharge planning process and that its success depends on the level of case manager involvement, the rapport established between the patient and the peer, and the quality of their developing relationship. It was also found that for the peer linkage to be successful, it must be arranged within two days of the patient's discharge.The linkage of patients with their peers in the community is a normalizing intervention that helps ease patients' transition from a highly structured ward milieu, which is often their only social support system. Replacing such supports by facilitating an active relationship with a peer is an opportunity to model "wellness" that cannot be duplicated by mental health professionals or therapeutic groups. Such an intervention also provides a social structure that is accepting and empowering. A more formal and comprehensive peer support program is currently being developed within the hospital.Mr. Bjorklund is a psychiatric social worker at Eastern State Hospital. For more information, contact him at the social work department at Eastern State Hospital, P.O. Box A, Medical Lake, Washington 99022 (e-mail, [email protected] dshs.wa.gov). FiguresReferencesCited byDetailsCited ByJournal of Psychiatric and Mental Health Nursing, Vol. 17, No. 2Physical Activity Preferences and Perceived Barriers to Activity Among Persons With Severe Mental Illness in the United KingdomMichael Ussher, Ph.D., M.Sc.Liam Stanbury, M.B.B.S., B.Sc.Vicky Cheeseman, M.B.B.S., B.Sc.Guy Faulkner, Ph.D., M.Sc.1 March 2007 | Psychiatric Services, Vol. 58, No. 3 Volume 51Issue 10 October 2000Pages 1316-1316 Metrics History Published online 1 October 2000 Published in print 1 October 2000