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There has been much debate about the most appropriate site for in‐patient psychiatric care for people with learning disabilities. The evidence base for service delivery for this group is very scant. Even less is known about the experiences of service users and their carers, as their voices have been largely absent from this debate among service providers and policy makers. This article summarises results from a study into the experiences of adults with learning disabilities who were admitted for in‐patient psychiatric care. Their carers' views were also investigated. Differences between generic and specialist provision are considered, and implications for service delivery are discussed. Generic services in particular would appear in need of considerable improvements if they are to meet the needs of people with learning disabilities in line with current policy guidelines. Recommendations for improvement include greater sensitivity of staff to the needs of this group, increased provision of accessible information about treatment options and medication, and more careful consideration of the need to involve regular carers during the admission.

The purpose of this paper is to test the psychometric properties and dimensionality of a new instrument, quality in psychiatric care (QPC), and to describe and compare quality of care among in‐patients as measured by this instrument.

The instrument quality in psychiatric care measures patients' experiences regarding quality of care. The instrument is based on a definition of quality of care from the patients' perspective. A sample of 265 in‐patients at eight general psychiatric wards in Sweden was assessed.

Exploratory factor analysis revealed that the original five‐dimensional 69‐item QPC was better with six dimensions and reduced to 30 items, hereinafter denoted quality in psychiatric care‐in‐patients (QPC‐IP) with retained internal consistency. The patients' ratings of quality of care were generally high; the highest rating was for quality of encounter and the lowest for participation.

Analysis of the dropouts was not possible because of incomplete registrations at the wards.

QPC‐IP is a simple, inexpensive and quick way to evaluate quality of care and thus contributes to health care improvement in the field of psychiatry.

The new 30 items instrument, QPC‐IP includes important aspects of patients' perceptions of quality of care. The QPC‐IP is psychometrically adequate and thus recommended for evaluating patients' experiences of the quality of psychiatric care.

In many UK mental health services, in-patient psychiatric care is being separated from community care by having dedicated in-patient medical team. We evaluated staff satisfaction in this functionalised in-patient care. A survey was conducted amongst multidiscipli-nary staff from various teams using a questionnaire survey. On an average 14.3% of staff returned a satisfactory response for function-alisation, 57.3% had unsatisfactory response and others were undecided or perceived no change. There was no difference in responses amongst age, gender and professional groups. Mean scores of all groups were within unsatisfactory domain; however community staff compared to in-patient staff and staff with more than 5 years of experience compared to those with 1-5 years of experience returned significantly more unsatisfactory responses regarding functionalisation. Many positive and negative aspects of functionalisation were raised. The results of this evaluation suggest the need for further studies on the effectiveness of in-patient functionalisation. Short and long term clinical outcomes and the satisfaction of the patients should also be studied.

The principal aim of this paper is to develop an instrument to measure quality of care in the psychiatric setting from an in‐patient perspective and to describe quality of care by means of this instrument. A further aim is to investigate the influence of background variables and expectations on the experience of care.

The instrument “Quality in psychiatric care” consists of two parts: one for measuring the patient's expectations regarding quality of care, the other for measuring his or her experiences regarding it. The instrument was derived from an earlier interview study of patients' perceptions of the quality of psychiatric care. A sample of 116 patients from eight in‐patient wards in Sweden participated in the present study.

Results indicate a generally high quality of care. Experienced quality of care was significantly lower, however, than expectations in all the dimensions of the instrument: total dimension, dignity, security, participation, recovery and environment. Patients who perceived that the time of discharge was consistent with the stage of their illness experienced significantly higher Recovery; patients with good psychiatric health experienced this too, but also significantly higher participation.

This new instrument needs to be further tested before the psychometric properties can be established.

The value of the research is that instruments for measuring the quality of in‐patient psychiatric care from the patient's perspective and with a theoretical foundation are less common.

Self‐reported quality of life (QOL) was examined in a cohort of detained psychiatric in‐patients. Two patient groups, categorised as high and low on the Lehman Quality of Life Interview (QOLI) in terms of their ‘satisfaction with life in general’, were compared. A model of satisfaction with life derived from a logistic regression analysis contained three measures: (high) QOLI satisfaction rating for living situation, (low) suicidality and (high) motivation and energy. The practical implications of these findings are discussed in terms of assessment, symptom relief and environmental change.

The purpose of this paper is to present a qualitative analysis of the facilitators of recovery in in-patient psychiatric rehabilitation from the service users’ perspective.

Interviews with 31 in-patients were coded and analysed thematically at an interpretive level using an inductive approach.

The dominant themes identified were hope, agency, relationships and opportunity. Totally, 20 subthemes were identified. Agency was more important to men than women and agency, hope and relationships were all more important to detained patients.

Interview data were collected in writing rather than taped. The results may not be transferrable to patient populations with significantly different demographic or service factors.

Services need to target interventions at the areas identified by service users as important in their recovery. The findings suggest both environmental and relational aspects of care that may optimise recovery. Services also need to be able to measure the quality of the care they provide. A brief, culturally valid and psychometrically assessed instrument for measuring the recovery orientation of services is required.

As far as the authors are aware no qualitative work to date has examined the recovery experiences of psychiatric rehabilitation in-patient service users in order to understand what services require to do to enable recovery from their perspective. The conceptual framework identified in this paper can be used to develop a service user self-report measure of the recovery orientation of services.

Two censuses, from 2010 and 2013, respectively, shed light on the trend in use of in-patient psychiatric care for people with learning disability or autism following the BBC documentary exposing abuse of patients at Winterbourne View. The purpose of this paper is to consider the implications of the detailed trends for future care for this group.

Published data from a recent (September 2013) census are compared with the re-analysis of a census undertaken by the Care Quality Commission in March 2010.

An overall 35 per cent reduction in numbers of in-patients is made up of larger falls in groups generally easier to discharge (older, female, in general as opposed to secure units). There is also substantial variation around the country.

There are some uncertainties about the comparability of the two censuses and the question of how complete enumeration was of people with learning disabilities in general mental illness beds.

The paper raise the question of whether the beds that are reducing fastest may be those most likely to be of value to a high quality and sustainable service in the long term.

The paper outlines a model for addressing clinical effectiveness, and an illustration of how this is practically implemented through team working in a multidisciplinary in‐patient environment. This is particularly relevant given the number of recent reports that highlight the need to develop and invest in the in‐patient services. The difficulty in implementing evidence‐based practice for mental health interventions is also addressed and initiatives being developed to enable a realistic approach in such an environment are described. The paper describes a structure and a process, using examples from audit, research and other initiatives particular to the unit, in providing accessible evidence based interventions for ward based staff, and improved clinical effectiveness generally.

There are considerable differences between the USA and the UK in terms of the practice of in‐patient care, particularly in the use of restraint. The American legal system defines restraint in terms of physical, mechanical, and chemical restraints, of which only physical and chemical restraints are routinely used in the UK. There is a need to agree a standard definition of restraint as it is used in the UK, which may be valuable as one proxy for quality. Such information would enable nurses to make appropriate use of the published literature, make valid comparisons within and between institutions, and provide evidence about the kind of nursing education and nursing practice development needed to produce quality patient care.