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Development of a Virtual Reality Assessment of Everyday Living Skills

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How Inpatient Psychiatric Units Can Be Both Safe and Therapeutic.

Matthew L Edwards¹, Nathaniel P Morris²

¹Assistant professor of psychiatry and an assistant training director of the General Psychiatry Residency Program in the Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine in Stanford, California.

AMA Journal of Ethics

|March 6, 2024

Summary

Inpatient psychiatric units face pressure to become more controlling due to safety concerns, potentially hindering patient dignity and recovery. Strategies are needed to balance safety with therapeutic environments that support patient well-being.

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Area of Science:

Psychiatry
Healthcare Management
Patient Safety

Background:

Inpatient psychiatric units aim to be therapeutic environments fostering dignity and recovery.
Adverse events like self-harm and violence can lead to litigation and pressure for increased control.

Purpose of the Study:

To describe the 'safety funnel' phenomenon in psychiatric settings.
To propose strategies for balancing safety, humanity, and recovery.

Main Methods:

Conceptual analysis of environmental pressures in psychiatric units.
Review of risk management vs. therapeutic milieu.

Main Results:

A 'safety funnel' effect drives inpatient psychiatric environments toward increased control and reduced patient autonomy.
This trend can negatively impact patient dignity and recovery by limiting access to personal items, exercise, and privacy.

Conclusions:

Balancing stringent safety measures with a humane, recovery-oriented approach is critical.
Implementing strategies to mitigate the 'safety funnel' is essential for effective inpatient psychiatric care.