The treatment of ‘difficult’ patients in a secure unit of a specialized psychiatric hospital: the patient’s perspective

• • 
  Some patients in psychiatric hospitals are considered difficult to treat. Their ongoing conflicts with nurses and other health care professionals can result in a deadlock in their treatment.
• • 
  In these cases, patients can be transferred to another specialist hospital. The research described below was conducted in such a specialist psychiatric hospital. The researchers asked the patients how they felt about their treatment and how it helped them recover.
• • 
  The patients found the treatment very strict: they had to make commitments and to follow numerous rules concerning eating times, privileges and safety. Also the professionals pointed out the patient’s own responsibility for the success of the treatment.
• • 
  The patients reported that the treatment had helped them considerably. Their anxiety, aggression and other symptoms had decreased. Their confidence increased, and they perceived their future with greater optimism.

The aim of this study is to obtain insight, from a patient’s perspective, into the results and essential components of treatment in specialist settings for so-called ‘difficult’ patients in mental health care. In cases where usual hospital treatment is not successful, a temporary transfer to another, specialist hospital may provide a solution. We investigated which aspects of specialist treatment available to ‘difficult’ patients are perceived as essential by the patients and what are the results of this treatment in their perception. A qualitative research design based on the Grounded Theory method was used. To generate data, 14 semi-structured interviews were held with 12 patients who were admitted to a specialist hospital in the Netherlands. Almost all respondents rated the results of the specialist treatment as positive. The therapeutic climate was perceived as extremely strict, with a strong focus on structure, cooperation and safety. This approach had a stabilizing effect on the patients, even at times when they were not motivated. Most patients developed a motivation for change, marked by a growing and more explicit determination of their future goals. We concluded that a highly structured treatment environment aimed at patient stabilization is helpful to most ‘difficult’ patients.