Women service users’ experiences of inpatient mental health services and staff experiences of providing care to women within inpatient mental health services: A systematic review of qualitative evidence

Scholes, Amy; Price, Owen; Berry, Katherine

doi:10.1016/j.ijnurstu.2021.103920

Cited by 8 publications

(10 citation statements)

References 43 publications

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“…Hospitalized patients are dislocated from their support systems, which may contribute to the onset or reenactment of trauma, particularly for those from collectivistic cultures. Seclusion and restraint are widespread practices for responding to violence or threats of violence in psychiatric settings (Fish & Hatton, 2017; Scholes et al, 2021). However, these methods can be psychologically and even physically damaging (Chieze et al, 2019).…”

Section: Relationally Oriented Trauma-informed Inpatient Care Frameworkmentioning

confidence: 99%

“…As cultivating an alliance is a robust predictor of effective treatment (Flückiger et al, 2018), providers can facilitate the formation of healthy connections during the inpatient stay. This involves viewing their relationships with patients as focal given that hospitalized women identify provider–patient bonds as the most instrumental factor in their satisfaction with inpatient treatment (Scholes et al, 2021). For women who have survived interpersonal and racial trauma, providers can work toward building trust (Comas-Díaz, 2016; Herman, 2015).…”

Section: Recommendations For An Integrated Approach To Trauma-informe...mentioning

confidence: 99%

“…Psychiatric admissions feel disempowering, particularly involuntary commitment. Even when interventions are not mandatory, many patients feel pressure to follow unit rules or treatment recommendations (Scholes et al, 2021). Patients may face barriers to self-advocacy due to their mental health status, power imbalances with providers, and stigma or shame (Shields et al, 2018).…”

Section: Relationally Oriented Trauma-informed Inpatientmentioning

confidence: 99%

“…Yet, traumainformed inpatient care is challenging to implement. Providers often lack the time, resources, or expertise to assess patients' trauma histories and listen to trauma narratives (for a review of staff and patient perspectives, see Scholes et al, 2021). Providers may lack the ability to evaluate and treat CPTSD adaptations, leaving them disoriented and frustrated (Courtois & Ford, 2012).…”

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confidence: 99%

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Trauma-informed inpatient care for marginalized women.

Gutowski¹,

Badio²,

Kaslow³

2022

Psychotherapy

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Although optimal trauma-informed care in inpatient settings is relationally oriented, gender-sensitive, racially and culturally responsive treatment, this often is not the reality. Instead, inpatient settings frequently create experiences of retraumatization, which likely are associated with poor outcomes. This article extends the literature on trauma-informed care by drawing from existing models for working with trauma and providing culturally responsive treatment to apply an integrated approach to the inpatient care setting with a focus on the unique needs and experiences of marginalized survivors of gender-based violence and racial trauma. It details the rationale for and key elements of three related frameworks for trauma-informed care and then offers recommendations for guiding its conceptualization and implementation. Ideally, these practices will be embraced on all inpatient units and particularly with women from marginalized communities who have survived interpersonal and racial trauma. Clinical Impact StatementQuestion: How can inpatient providers integrate relationally oriented, gender-sensitive, racially and culturally responsive models into trauma-informed practices? Findings: We offer key elements of these three related frameworks followed by a series of recommendations for integrating these perspectives into clinical practice. Meaning: Trauma-informed providers in the inpatient context can embrace this integrated, social justice-oriented approach to respond to the needs of hospitalized survivors, particularly marginalized women who have survived interpersonal and racial trauma. Next Steps: Trauma-informed care that is relationally oriented, gender-sensitive, and racially and culturally responsive is a recommended approach for all inpatient psychiatric units moving forward.

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Section: Relationally Oriented Trauma-informed Inpatient Care Frameworkmentioning

confidence: 99%

Section: Recommendations For An Integrated Approach To Trauma-informe...mentioning

confidence: 99%

Section: Relationally Oriented Trauma-informed Inpatientmentioning

confidence: 99%

mentioning

confidence: 99%

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Trauma-informed inpatient care for marginalized women.

Gutowski¹,

Badio²,

Kaslow³

2022

Psychotherapy

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“…This literature is supplemented by research in specialized forensic (14)(15)(16)(17)(18), general hospital (19)(20)(21)(22), and outpatient mental health (23)(24)(25)(26) settings. Many papers examine the experiences of women (6, 7,11,12,15,18,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46], while the perspectives of men are notably absent in much of the qualitative research. This can be partially explained in terms of a phenomenon of "concealment" whereby men are more likely to mask indicators of vulnerability, ultimately lending to outsiders being "blinded" to male trauma experiences (47).…”

Section: Introductionmentioning

confidence: 99%

Gender and intersecting vulnerabilities on the mental health unit: Rethinking the dilemma

et al. 2022

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BackgroundGender is routinely pitched as a key determinant of vulnerability for staff and residents on acute mental health inpatient units. Since the 1960's mixed gender units have become more prominent in Western health systems, yet questions remain around the configuration of these units, including how to ensure emotional and physical safety of those living and working in them.MethodsThis paper draws on a large study of the lived experiences of 42 staff and 43 service users from different acute mental health units in New Zealand. We conducted thematic analysis of interview data from four units with diverse architectural layouts to identify key themes central to decisions around gender and spatial design.ResultsKey themes emerged around gender-related trauma histories, safety perceptions and vulnerabilities, accommodation of gender-diverse and non-binary mental health service users, and gender-specific needs and differences. A further theme, of it goes beyond gender emphasized that there are many other non-gender attributes that influence vulnerability on the unit.ConclusionsWhile findings emphasize the need for safe places for vulnerable people, trauma-informed care, access to staff who “understand,” and recreation that is meaningful to the individual, we question if the dilemma of gender-separation vs. gender-mixing is an outmoded design consideration. Instead, we argue that a flexible, person-centered approach to provision of care, which values autonomy, privacy, and safety as defined by each service user, and that promotes choice-making, obviates a model where gender accommodations are fore. We found that a gender-exclusive narrative of vulnerability understates the role of other identifiers in dynamics of risk and vulnerability, including age, physicality, past violence, trauma history, mental unwellness, and substance use. We conclude gender need not be a central factor in decisions around design of prospective built unit environments or in occupational and clinical decisions. Instead, we suggest flexible spatial layouts that accommodate multiple vulnerabilities.

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