The design and function of inpatient wards

Inpatient wards in asylums were the cradle of modern psychiatry and have remained a central component ever since, even in the most radical services. Their configuration has evolved pragmatically but since the arrival of evidence-based practice in mental health care in the early 1980s, attempts have been made to derive guidelines and provide principles for their design. There is little in the way of experimental evidence but there is a growing international consensus. Wards now strive to be small (around 15–20 places) and to provide single en-suite accommodation. Isolated small wards emphasizing a domestic configuration have generally faced problems with caring for disturbed patients. The last decade has seen a disappointing move back to single-sex wards, with greater emphasis on security and doors often locked as bed numbers have fallen and patient acuity has increased. International observations are provided about staffing, design, and standards.