Therapeutic milieu and clinical improvement

While studies of the interpersonal environment of psychiatric hospitals have compared one ward or unit with another, there are no reports relating a patient's perception of a treatment unit to his clinical coruse on the unit. In this study conducted on an acute psychiatric ward of a general hospital, the Community Oriented Program Environment Scale (COPES) of Rudolph Moos was used as a measure of the patient's conception of an ideal ward and the patient's perception of the actual ward. The Nurses Observation Scale for Inpatient Evaluation (NOSIE) was used to rate psychopathology. Patient's perceptions of the actual ward, of an ideal ward, and differences between actual and ideal were not related to initial pathology or improvement over time. Research and clinical implications of these findings are discussed.