The Relationship between Therapeutic Alliance and Service User Satisfaction in Mental Health Inpatient Wards and Crisis House Alternatives: A Cross-Sectional Study

Abstract

BackgroundPoor service user experiences are often reported on mental health inpatient wards. Crisis houses are an alternative, but evidence is limited. This paper investigates therapeutic alliances in acute wards and crisis houses, exploring how far stronger therapeutic alliance may underlie greater client satisfaction in crisis houses.Methods and FindingsMixed methods were used. In the quantitative component, 108 crisis house and 247 acute ward service users responded to measures of satisfaction, therapeutic relationships, informal peer support, recovery and negative events experienced during the admission. Linear regressions were conducted to estimate the association between service setting and measures, and to model the factors associated with satisfaction. Qualitative interviews exploring therapeutic alliances were conducted with service users and staff in each setting and analysed thematically.ResultsWe found that therapeutic alliances, service user satisfaction and informal peer support were greater in crisis houses than on acute wards, whilst self-rated recovery and numbers of negative events were lower. Adjusted multivariable analyses suggest that therapeutic relationships, informal peer support and negative experiences related to staff may be important factors in accounting for greater satisfaction in crisis houses. Qualitative results suggest factors that influence therapeutic alliances include service user perceptions of basic human qualities such as kindness and empathy in staff and, at service level, the extent of loss of liberty and autonomy.Conclusions and ImplicationsWe found that service users experience better therapeutic relationships and higher satisfaction in crisis houses compared to acute wards, although we cannot exclude the possibility that differences in service user characteristics contribute to this. This finding provides some support for the expansion of crisis house provision. Further research is needed to investigate why acute ward service users experience a lack of compassion and humanity from ward staff and how this could be changed.

A systematic review of factors associated with service user satisfaction with psychiatric inpatient services

“…The qualitative papers generally scored well for reporting the analysis used, but there was little or no acknowledgement of the impact of the researcher on the research process. The four mixed methods papers scored 0% (Lovell, 1995), 25% (Sweeney et al, 2014), 50% (Greenwood et al, 1999) and 75% (Ricketts, 1996) respectively.…”

“…Five studies (Greenwood et al, 1999;Kohler et al, 2015;Ricketts, 1996;Smith et al, 2014;Sweeney et al, 2014) reported a mean score of the Client Satisfaction Questionnaire (CSQ-8/ZUF-8), with scores ranging from 21 to 26.8 (mean score 23.53). The CSQ-8 consists of a range of potential scores from 8 to 32, with higher scores indicating greater satisfaction.…”

“…Studies reported a positive association between the quality of the therapeutic relationship and satisfaction with services (Howard et al, 2003;Kuosmanen et al, 2006;Olusina et al, 2002;Sweeney et al, 2014;Zendjidjian et al, 2014). In particular, staff supportiveness (Middelboe et al, 2001), accessibility (Rose et al, 2015;Wallace et al, 1999), and capability (Stewart et al, 2015) were related to satisfaction.…”

Peer Worker Roles and Risk in Mental Health Services: A Qualitative Comparative Case Study

“…There was acknowledgement that, while retaining moral and ethical responsibility, peer workers in peer-led organisations were not bound by the same legal duty of care as a statutory service provider and as such were able to work more flexibly, enabling service users to own their own risks as part of a therapeutic process (Morgan 2000). It has been suggested that encouraging a personal sense of autonomy in this way is not only of therapeutic value in its own right but supports a virtuous circle of improved relationships between staff and service users (Sweeney et al 2014).…”

Developing a measure of mental health service satisfaction for use in low income countries: a mixed methods study

“…In the context of mental health care, dissatisfaction with care received has been found to be associated with adverse outcomes: lack of service uptake, poor therapeutic alliance, discontinuation of care, a higher number of unmet needs and lower quality of life [7–11]. However, consistently high levels of satisfaction reported in studies have prompted researchers to warn that caution needs to be exercised in the interpretation of results [12].…”