The impact of a changed environment on arousal levels of patients in a secure extended rehabilitation facility

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. 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. 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. The physical environment of long-stay rehabilitation wards may influence aggressive behaviour and arousal in chronically ill patients.