Adolescents’ experiences of distress on an acute mental health inpatient unit: A qualitative study

Abstract

Adolescents admitted to acute mental health inpatient units can experience episodes of distress for numerous reasons. Little is known about how they attempt to cope with this distress. This paper explores adolescent experiences of distress in an acute mental health inpatient unit. Fifty hours of non‐participant observations were conducted and documented using a critical incident technique (CIT) framework. An interpretive descriptive approach was used to analyse the observation data collected. Nineteen episodes of adolescent distress were observed and five themes emerged, of which two will be explored in this paper: clinical contexts and triggers, and coping or help‐seeking actions. The findings of this study will help mental health nurses working on acute adolescent units understand how adolescents attempt to cope with, and seek help for, episodes of distress, and enhance early responses to prevent escalation of distress.

Interventions to reduce self-harm on in-patient wards: systematic review

“… 43 There are a number of ways that ward-based interventions could have an impact on patient self-harm. These include, increasing the presence of staff available for patients to seek help and feel supported, 22 , 73 providing positive and safe ways to distract patients and help them to bond with their peers to replace the positive functions associated with self-harm. 74 – 76 In addition, ward-based activities and interventions may help to reduce the sense of isolation, restriction and loneliness that patients often feel on psychiatric wards that may trigger self-harming behaviours.…”

“…Patients may be distressed by interaction with other in-patients, by the rules and routines of life on the ward, the amount of leave granted or by the restrictions of involuntary admission. 3 , 21 , 22 Feeling lonely, being isolated from others and a lack of stimulation can all contribute to self-harming behaviours on psychiatric wards. 23 , 24 Patients may use self-harming behaviour as a way of seeking help when they do not feel supported by nursing staff on wards.…”

Environmental changes to reduce self-harm on an adolescent inpatient psychiatric ward: an interrupted time series analysis

“…The risk factors of self-harm with both non-suicidal and suicidal intent are complex and include age, gender, mental health diagnosis, coping strategies, previous self-harm, acute stress response, relationship with family and friends, as well as social deprivation [7,[23][24][25][26][27]. The likelihood of self-harm is also influenced by more immediate contextual factors such as social influences and the environment of care on inpatient psychiatric wards [12,23,28,29].…”

“…DBT and CBT have been adapted and implemented within inpatient settings and have reduced self-harming behaviours in adolescents [37,[39][40][41][42][43]. However, the ward environment also plays a key role in the success of these treatments and can actively contribute to self-harming behaviours in adolescents [12,23,28,29]. Safety analysis in other areas of healthcare, and in other industries, also suggest that wider organisational and environmental factors are important contributory factors to safety incidents [44].…”

“…Young people in the community also report more self-harming thoughts when they are alone [ 35 ] and usually consider self-harm a private act, to be done in secrecy [ 36 ]. The social relationship between adolescents and nursing staff on psychiatric wards can also influence self-harming behaviours, as young people reportedly harm less when nursing staff intervened during early warning signs of distress [ 28 ]. As indicated by the interpersonal function of self-harm, it is possible that patients may use self-harming behaviour to seek help when they do not feel supported by nursing staff on wards [ 3 , 5 ].…”