• A conceptual model for designing psychiatric wards to reduce stress and aggression is described.
• The model identifies ten ward design features that may help reduce aggression.
• We hypothesized that aggression would be lower in hospitals with several compared to few design features.
• Injections for aggression were reduced in a new hospital with nine features compared to hospitals with one.
• Restraint use declined 50% in the new hospital compared to an older facility it replaced.
The article describes a conceptual model proposing that aggression in psychiatric facilities may be reduced by designing the physical environment with ten evidence-grounded stress-reducing features. The model was tested in a newer hospital in Sweden having wards with nine of the ten features. Data on two clinical markers of aggressive behavior, compulsory injections and physical restraints, were compared with data from an older facility (replaced by the newer hospital) that had only one stress-reducing feature. Another hospital with one feature, which did not change during the study period, served as a control. The proportion of patients requiring injections declined (p<0.0027) in the new hospital compared to the old facility but did not change in the control hospital. Among patients who received injections, the average number of injections declined marginally in the new hospital compared to the old facility, but increased in the control hospital by 19%. The average number of physical restraints (among patients who received at least one) decreased 50% in the new hospital compared to the old. These findings suggest that designing better psychiatric buildings using reasoned theory and the best available evidence can reduce the major patient and staff safety threat posed by aggressive behavior.
Roger S. Ulrich, Lennart Bogren, Stuart K. Gardiner, Stefan Lundin
Journal of Environmental Psychology, Volume 57, June 2018