Exploring the Use of Digital Picture Frames on Schizophrenia Inpatient Wards

Psychiatric inpatient settings are routinely described as challenging care environments, with poor physical facilities and problematic interactions with staff routinely cited. Individuals with mental illness, particularly those with schizophrenia, often struggle to sustain a non–illness-oriented sense of self in such settings. Similarly, inpatient staff can lose a holistic sense of the individuals whom they are treating because their interactions with patients take place almost exclusively in periods of crisis. In this context, we considered whether digital picture frames might be a useful therapeutic tool. We expected that the process of developing, viewing, and discussing a set of meaningful photographs between patients and staff would stimulate aspects of patients’ self-concepts that are unrelated to mental illness, prompt more holistic and individualized conversations, and improve patients’ physical environment.

To test the feasibility of using these devices and their potential impacts, we installed digital frames in the rooms of five individuals with schizophrenia (four males; mean±SD age=42±9; length of stay=14±15 months) on a unit in a large psychiatric care facility in Toronto, Ontario. We documented patients’ experiences of having the devices installed in their rooms as well as the experiences of allied health and nursing staff.

The installation of the digital picture frames involved several steps. First, a set of personally meaningful photographs was obtained either from patients’ family members or from online sources, including Google Images. Student researchers and the unit social worker assisted in the search for photographs and uploaded them onto the devices. They were then encased in a protective wooden frame and installed. The photographs played continuously during daytime hours, and patients could turn the device on or off as they desired. In weekly check-ins, patients had the opportunity to exchange or add new photographs.

The prompting of patients in the picture search-and-selection process opened up discussions about previous occupations, interests, hobbies, and childhood memories. The patients soon were immersed in the process—sharing stories and wanting to add more pictures. They came to describe the picture frames as a therapeutic and meaningful part of the recovery process. They described how having the digital picture frame in their rooms gave them “something to look forward to” and cultivated a sense of wellness. Viewing the pictures was described as “soothing [my] mind” and working as “some kind of deterrent” when in distress.

The picture frames also provided the participants with opportunities to revisit and represent key aspects of their sense of self outside of having a mental illness. Participants variously described the photographs as connecting them with their cultural identities (“I was happy to see my own culture”), prompting good memories, and noting that the photographs were “a good reminder of family and friends.” Most patients did not have any photographs on their walls prior to involvement in this project. They described how having the picture frames in their rooms created a more positive and personalized environment, “brighten[ing] up the room.”

The picture frames appeared to promote communication between unit staff and participants about topics outside of mental illness. Patients reported having short conversations about the photographs, leaving some with the impression that staff found viewing the photographs interesting and that they helped staff to “get to know me a little bit better.” In turn, staff ranged from some not being aware that the devices had been installed to others who highlighted the device’s utility. One staff member shared an experience in which she was able to redirect the patient to the photographs on the digital picture frame when he became frustrated, which was very helpful in deescalation. Another staff member felt that the device gave patients the opportunity to “express who they are outside of the illness.” She found having conversations with the patients about their photographs “changed the dynamic between the treatment team, as clients showed [the team] another side of their life.”

Both developing content for the digital picture frames and using them appear to hold considerable potential for the device as a therapeutic tool. Further study regarding impacts would seem warranted, as would a more fulsome articulation of this approach as an intervention. This work is important given the challenging nature of inpatient treatment contexts and the need for recovery-oriented tools to move practices forward in inpatient care.

In summary, digital picture frames are feasible to use on psychiatric inpatient wards and hold the potential for cultivating a more therapeutic physical environment, assisting in maintaining a nonillness identity, and facilitating wellness-oriented interactions with staff.