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Tree Template.

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on 7 May 2015

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Transcript of Tree Template.

Occupational Enablement
Person Environment Occupation (PEO)
Alfred Psychiatry
Sensory Room
What is a sensory room?

What evidence is there?
Interior design
Outdoor Area
Low Dependency unit
High Dependency Unit (HDU)

Comprehensive or increased levels of individual care
High staff to patient ratio
Low stimulus environment
Safety and security is a priority
Minimal OT input - lack of resources
Phase 1:


Phase 2:

Scoping and planning

Phase 3:

Implementation of information gathering

Lack of structured OT input
Lack of sensory and occupational opportunities

Literature review
Feedback from Alfred Consumers
Interviews Health workers at the Alfred and at external agencies
Additional Research
- Consumers of the inpatient mental health services available through Alfred Health.
- Residents of the South Eastern suburbs of Melbourne and surrounding areas.
- Family members: Parents, siblings, cousins, aunts and uncles.
- Workers; employers and employees
- Students.
- Friends.

- Patients in an acute stage of mental illness which makes it difficult for health workers to engage.
- Limited resources available for participation in meaningful activities.
- Security and safety concerns in a restrictive environment.

Phase 4:

Complete bound manual of recommendations

Phase 5:

Handover and final reporting
PHYSICAL: Inpatient High-Dependency Unit (HDU) of The Alfred Hospital.
SOCIAL: Mental illness is a taboo subject, one that is not usually addressed openly in society.
CULTURAL: Mental illness is a 'hidden disease', which can be masked by a variety of factors.
SOCIOECONOMIC: Underfunded in relation to the scope of the problem.
INSTITUTIONAL: Inpatient Psychiatric Unit for the acutely unwell - Part of the Psychiatric services available through Alfred Health to service the South Eastern suburbs of Melbourne.
Outdoor area has a positive effect on the well-being of patients in the HDU.

Current outdoor area under-utilised and minimally supportive of occupational engagement.

Ambient Features
Interior Design
Sensory Room
Seclusion Room
Exercise Equipment
Outdoor areas
Social Features
Architectural Features
Homely design Vs Institutionalized feel
Promote emotional wellbeing and provide feeling of comfort
Short term:
Long term: Rebuilding the HDU
What feedback did the consumers give?
What did we learn from health workers from Alfred Psychiatry and external agencies?
Long-term Recommendations:
1) General maintenance.
2) Increase available space.
3) Introduction of natural elements.
4) Decorate the space.
5) Decrease the institutionalised feel.
1) Create more outdoor area space.
2) Utilise the 'roof space'.
3) Create an open area balcony.
Key Items:
Massage chair
Music player
Glider chair
Selection of small sensory items for each of the senses.
Time spent in the room


Assess each consumer's sensory preferences

Training for staff
1) Mental health research - Physical environment.

2) Time management - Project planning.

3) Stakeholder conflict - Ethical considerations.

4) Resources - Technology and transport.
Short-term Recommendation:
Interior design/Decoration
Sonya Vargas (La Trobe Unversity supevisor)
Kate Dunne, Jonathan Smith, Anton Horvat, Freya Coker (Alfred Health project sponsors)
Health workers from external agencies
Therapeutic environment
Decreased supervision
Occupational therapy input
These environmental recommendations are currently guiding modifications of the Alfred HDU
Office of the cheif psychiatrist , (2002)
(Law, Cooper, Strong, Stewart, Rigby & Letts, L. 1996)
Significant risk of harm to others
Significant risk of harm to self
Significant risk of absconding
Significant disruption to the ward environment
Patient request if deemed appropriate
Warm blue tones or earthy colours
Soothing or personal artwork for display
Carpet floor Vs Lino
Indoor plants
Modifications to the Physical Environment of the Alfred Acute Inpatient Psychiatry
Service (High Dependency Unit) to Improve Consumer Occupational Enablement and Well-being

Pavi Karthikeyan, Izabella Mambort & Hannah More
1.) Did you find the temperature in the HDU to be unpleasent?

a.)What would you change?

i.) Do you feel like these unpleasent smells affect your mood?

Sensory Box
(Inter-IKEA Systems B.V, 2014)
(Masters Home Improvement, 2014)
(Masters Home Improvement, 2014)
(Masters Home Improvement, 2014)
Incorporate sensory approach into policy documents
Evaluate outcomes
Share manual with other agencies
Future project recommendations
Evidence-based and appropriate interventions for use in a HDU environment, including sensory interventions

Prior ethical approval for students to interact with consumers
HDU Common Area
Patient rooms
Fireproof bean bags
Different coloured furniture
Single seaters.
Movable furniture
Audit tool for maintenance of furniture.
Non glaring casing for common television.
Televisions in each room
Desk and chair in rooms

Interior Design

Law, M., Cooper, B,. Strong, S., Stewart, D., Rigby, P. & Letts, L. 1996. The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy. 63(1): 9-23.

Masters Home Improvement, 2014 [image]. Retrieved 19 November from: https://www.masters.com.au/media/MASTERS/Product/1000x1000/x101158940_0_9999_v1_m56577569831431582.jpg.pagespeed.ic.1SWRqf-cgd.jpg

Masters Home Improvement, 2014 [image]. Retrieved 19 November from: https://www.masters.com.au/media/MASTERS/Product/1000x1000/101132846_0_9999_v1_m56577569831431621.jpg

Masters Home Improvement, 2014 [image]. Retrieved 19 November from: https://www.masters.com.au/media/MASTERS/Product/1000x1000/900013558_0_9999_v1_m56577569831018855.jpg

Inter-Ikea Systems B. V., 2014 [image]. Retrieved 19 November from: http://www.ikea.com/au/en/images/products/ullkaktus-cushion__0276348_PE414782_S4.JPG
Dwyer, J., Liang, Z., Thiessen, V., & Martini, A. (2013). Project Management in Health and Community Services: Getting good ideas to work (2nd ed.). Australia: Allen & Unwin.

Karlin, B., & Zeiss, R. (2006). Patient-centred improvements in healthcare built environments: perspectives and design indicators. Psychiatric Services, 57(10), 1376-1378.

Kielhofner, G. (2008). Model of human occupational therapy: theory and application (4th ed.). Philadelphia: Lippincott Williams & Wilkins.

Lee, S. J., Cox, A., Whitecross, F., Williams, P., & Hollander, Y. (2010). Sensory assessment and therapy to help reduce seclusion use with service users needing psychiatric intensive care. Journal of Psychiatric Intensive Care, 6(02), 83-90.

Mayers, P., Keet, N., Winkler, G., & Flisher, A. J. (2010). Mental Health Service Users' Perceptions and Experiences of Sedation, Seclusion and Restraint. International Journal of Social Psychiatry, 56(1), 60-73. doi: 10.1177/0020764008098293

Mental Health, Drugs & Regions Division of the State Government Department of Health, Victoria, Australia (2014). General Adult Mental Health Services. Retrieved from http://www.health.vic.gov.au/mentalhealth/services/adult/index.htm

Mullen, B., Champagne, T., Krishnamurty, S., Dickson, D., & Gao, R. (2008). Exploring the Safety and Therapeutic Effects of Deep Pressure Stimulation Using a Weighted Blanket. Occupational Therapy in Mental Health, 24(1), 65-89. doi: 10.1300/ J004v24n01_05

Novak, T., Scanlan, J., McCaul, D., MacDonald, N., & Clarke, T. (2012). Pilot study of a sensory room in an acute inpatient psychiatric unit. Australasian Psychiatry, 20(5), 401-406.

Office of the Chief Psychiatrist (2002). High Dependency Unit Guidelines. Department of Human Services Victoria.
Pulsford, D., Crumpton, A., Baker, A., Wilkins, T., Wright, K., & Duxbury, J. (2013). Aggression in a high secure hospital: staff and patient attitudesjpm.
Journal of Psychiatric and Mental Health Nursing, 20, 296-304. doi: 10.1111/j.1365-2850.2012.01908.x

Sivak, K. (2012). Implementation of Comfort Rooms to Reduce Seclusion, Restraint Use, and Acting-Out Behaviors. Journal of Psychosocial Nursing and Mental Health Services, 50(2), 24-34.

Sutton, D., Wilson, M., Van Kessel, K. & Vanderpyl, J. (2013). Optimizing arousal to manage aggression: A pilot study of sensory modulation. International Journal of Mental Health Nursing, 22: 500-511. doi: 10.1111/inm.12010

Van der Schaaf, P., Dusseldorp, E., Keuning, F., Janssen, W., & Noorthoorn, E. (2013). Impact of the physical environment of psychiatric wards on the use of seclusion. The British Journal of Psychiatry, 202, 142-149. doi: 10.1192/bjp.bp.112.118422

Victorian Mental Health Act 2014. (Vic) (Austl.).
Are there any questions?

Leading upto Project.....
Agression and use of restrictive interventions
Growing body of evidence
Recovery oriented approach
Full transcript