What should an inpatient psychiatric care site look like?


Reducing patients’ risks of harm to themselves or others is an important factor in the design of inpatient psychiatric units, but it is not ethically neutral. Physicians and administrators should be aware of how patients’ experiences with the care environment can undermine the therapeutic goals of hospitalization.

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The March issue of AMA Journal of Ethics® (@JournalofEthics) investigates which criteria physicians and health professionals should use to assess and evaluate patients’ risk of harm to self or others and which values they should rely on to guide the iatrogenic harm risks they accept as products or byproducts of clinical and organizational environmental designs.

The March issue of AMA Journal of Ethics includes the following articles:

  1. How Should Suicide Prevention and Healing Be Expressed as Goals of Inpatient Psychiatric Unit Design?

    This commentary examines prevention policies that overly rely on liberty restrictions imposed by designs of inpatient psychiatric units’ structures and spaces.

  2. Should Dignity Preservation Be a Precondition for Safety and a Design Priority for Healing in Inpatient Psychiatry Spaces?

    Therapeutic security in inpatient psychiatric settings requires careful planning and implementation if it is to support patients’ safety and dignity.

  3. What Should Health Professions Students Know About Countertransference in Inpatient Psychiatric Environments?

    Inpatient psychiatric units are designed around the twin aims of treatment and containment, but emotional norms and tone also contribute to care environments.

  4. What Does the History of Inpatient Psychiatric Unit Design Tell Us About Balancing Safety and Healing for Patients With Suicidal Behaviors?

    Examining modern design trends in historical context is more clinically and ethically important than ever.

The journal’s March “Ethics Talk” podcast features a discussion with architect Stefan Lundin about how the design of mental health facilities contributes to safety and to patient healing.

The March issue also features nine author-interview podcasts. Listen to previous episodes of the “Ethics Talk” podcast or subscribe in iTunes or other services.

Also, CME modules drawn from this month’s issue are collected at the AMA Ed Hub™ AMA Journal of Ethics webpage.

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

The next issue of the journal will focus on global medical supply chain security. Sign up to receive email alerts when new issues are published.