Ward treatment milieu and posthospital functioning

Two units of seven and 14 state hospital wards were used in a study to explore possible relationships between some socio-cultural aspects of ward environments and outcome of treatment as assessed by time out of the hospital after discharge. Confounding variables such as pretreatment characteristics, length of hospitalization, and community of discharge make conclusions from many such studies tenuous. Methods were derived and are here described in detail that reduce the influence of some of these variables. Within unit 2 (14 wards), a vector of social structure that differentiated the wards and consisted of two highly correlated factors on the Ward Atmosphere Scale was found to be significantly associated with outcome. Those wards seen by both patients and staff as lower in the allowance of expression of anger and aggression and higher in order and organization (only staff's perception) had better outcomes. The wards of unit 1 were homogeneous both in outcome and in staff and patients' assessments of order and organization and freedom to express anger and aggression.