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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.

Mental health services in England have been transformed over the past three decades through the transfer of most care from hospital to the community, where services are available 24 hours a day. [1][2][3][4] It is therefore surprising that detentions under the Mental Health Act have risen steadily over the same time period. This has reached the point that with the declining number of beds, it is the norm for the majority of in-patients on many National Health Service (NHS) psychiatric wards to be detained at any point in time. The reasons for this remain unclear, and are complicated by spatial variation. For example, London has consistently higher rates of compulsory in-patient treatment compared with the rest of England.5 Previous studies of psychiatric in-patient treatment have demonstrated higher rates among younger adults, 6,7 and those of Black and minority ethnicity, 8,9 as well as in urban environments and areas of social deprivation. [10][11][12][13] However, a multilevel analysis of the rate of compulsory in-patient treatment identified that the majority of the variation in rates occurred at the individual level according to variables such as age and ethnicity.14 Area-level deprivation and ethnic density were also factors, but there was no independent effect of London once individual and area-level variables had been adjusted for. Our aims were therefore to record the rate of psychiatric in-patient treatment (voluntary and compulsory) in England in 2010/11 and describe the variation between rural and urban settings; to investigate whether the variation in these rates of in-patient treatment in rural and urban settings correlated with variations in levels of deprivation, ethnic density and age; and we hypothesised that differences in age, ethnic density and deprivation between urban and rural areas would explain differing rates of in-patient treatment. Method DesignThis was an ecological study based on secondary analysis of routinely collected national data. The proportion of adults who spent time as a psychiatric in-patient during a 1-year period was the outcome measure. Information on in-patient treatment was gathered from the Mental Health Minimum Dataset (MHMDS) for the year 2010/11. Data from the MHMDS was linked to corresponding demographic data from the Office for National Statistics 15 enabling rates to be calculated, and other variables to be measured including population age structure, ethnic density and levels of deprivation.The year studied was 2010/11. The population data used was the mid-2011 population estimates from the Office for National Statistics based on the results of the 2011 census. The 2010 Index of Multiple Deprivation (IMD) median score for each primary care trust (PCT) was used as a measure of arealevel deprivation (sourced from http://www.communities.gov.uk/ publications/corporate/statistics/indices2010).The setting was PCTs (geographically defined areas with a mean population size of 350 000, in which primary and secondary care NHS services were organised) in England. These ...

BackgroundTo improve health services, social, economic and health data should be shared and linked to create a full narrative of lived experience. Mental health data sharing is often considered a particularly sensitive area.ObjectiveTo assess mental health service users’ perceptions regarding the current practice of administrative data-driven research.MethodWe conducted a focus group using case study scenarios. Themes and subthemes were analysed using qualitative methods.ResultsParticipants were generally happy for data owners to share their health, social and economic data if the purpose was transparent and if the information would inform and improve health policy and practice. Participants were less keen on sharing data through digital applications.ConclusionThis case study informs a data linkage study protocol. Research teams and database owners should strive to educate service users on data protection and create dissent opportunities.