The Impact of a Changed Environment on Arousal Levels of Patients in a Secure Extended Rehabilitation Facility

Objective: This study sought to investigate the effect of changes of the physical ward environment on levels of arousal and aggression in long-stay patients in a secure extended rehabilitation facility. Method: Seclusion episodes, extended seclusion episodes, staff report of aggressive incidents and Brief Psychiatric Rating Scale (BPRS) measures of psychopathology were compared in the same group of long-stay rehabilitation patients over a period of 3 months before and 3 months after a move from a temporary, refurbished medical ward to a large, light-filled, purpose-built facility. Results: Fifteen patients were present during both investigation periods. The majority were male (80%) and had a diagnosis of schizophrenia (53%) or schizoaffective disorder (13%). There were statistically significant reductions in the mean number of seclusion episodes, mean number of extended seclusion episodes (> 4 hours) and BPRS total score following the move. There were statistically significant increases in ambient light conditions in the new unit. Conclusions: The physical environment of long-stay rehabilitation wards may influence aggressive behaviour and arousal in chronically ill patients.