Experiences of in-patient mental health services: systematic review

Abstract

BackgroundIn-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.AimsTo conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare.MethodA systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review.ResultsStudies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care.ConclusionsA number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.Declaration of interestK.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities.

Assessing and Improving the Quality in Mental Health Services

“…User evaluation is qualitative through interviews and complaint/suggestion boxes but also quantitative, through weighted questionnaires to which users can systematically respond, for example on the day of their dismissal from the clinic [55]. Factors that are playing an important role in forming patients' opinion is respect and trust, feeling safety, information and explanation about clinical decisions, and family involvement in the treatment and rehabilitation process [56,57]. Particular attention should be paid to the evaluation by patients of their experience of hospitalization with regard to the degree of application of the General Data Protection Rule (GDPR).…”

“…Violence in mainly verbal and rarely physical, and in danger are mainly male nurses who are working in the emergency psychiatry ward. Training in communication skills and de-escalating skills are important pillars of violence prevention in mental health services settings [56,67,68]. In addition to the security of individuals, the security of their personal data is of particular importance.…”

From the (Dis)comfort of One’s Own Home: Patients’ Experiences of Hospitalization After Discharge. A Qualitative Study of Lived Experience of Hospitalization from the Perspective of People with a Mental Health Disorder

“…Desse områda var samarbeid og inkluderande omsorg, positive forhold mellom pasient og helsepersonell samt eit trygt og terapeutisk miljø. Ein ny litteraturgjennomgang som har sett på publisert litteratur, hadde som mål å identifisere sentrale forbetringsområde innanfor psykisk helsevern (Staniszewska et al, 2019…”

Mental Health Patients’ Expectations about the Non-Medical Care They Receive in Primary Care: A Cross-Sectional Descriptive Study

“…Although paternalism has a long tradition in psychiatry, in recent decades, the development of autonomy has come to displace it. However, there are still some issues that generate controversy among health professionals, such as the fact that these patients often have their autonomy diminished, which could imply serious consequences for them [12]. The Madrid Declaration on People with Mental Disorders emphasises the importance of reciprocity, understood as trust and mutual respect, to allow the patient to make free and informed decisions [13].…”

“…Despite their scope, these issues may be minimised through the participation of professionals to make communication clearer and more intelligible. The practice of making shared decisions has been proposed as a strategy to promote communication between professionals and these patients [12]. Moreover, the implementation of shared decision-making has been associated with a reduction of fear and depression for the patient, and the improvement of their quality of life and satisfaction [18,19].…”