Disengaging from acute inpatient psychiatric care: a description of service users' experiences and views

Abstract

The growing number of people worldwide with mental health problems is increasing and making intensive demands on existing services. Recent reorganizations of healthcare provision in the UK have focused predominantly on administrative efficiency, standardization and cost-effectiveness. Although little evidence exists that reorganizations, per se, directly result in improved health nationally, nevertheless, organizational change coupled with improved care provision can have a considerable impact on the mental health of people. It is known that service users want person-centred help with improving their confidence, autonomy and cognitive and social skills so as to be able to manage their lives within the social context in which they live. In this study, semi-structured interviews were used to explore service users' expectations and experiences of acute inpatient care and the early post-discharge period. While the social environment of the wards was seen by many as conducive to promoting safety and interpersonal relationships, others found the experience lacking in assisting them to resume their lives post discharge. If acute care is to become more than a mechanism for addressing and containing risk, better targeted interventions are required to help individuals find strategies that are transferable to the context of their 'real' lives. A number of factors that were identified by respondents in this study are identified and discussed.

Implementing Recovery Model Principles as Part of Occupational Therapy in Inpatient Psychiatric Settings

“…The session topics that were most highly rated as beneficial included: identifying positive coping strategies, long-term goals, support systems, positive thoughts, and a balanced daily schedule. These results reflecting clients' personal experience with occupational therapy while hospitalized highly C. E. Synovec support previous research findings in both occupational therapy and recovery model literature (Gibson et al, 2011;Nolan et al, 2011). It is beneficial to note that the consumers identified evidence-based topic areas focusing on empowerment and occupational engagement as beneficial to their recovery, demonstrating a consistent relationship between occupational therapy and recovery concepts.…”

“…Social skills training is effective in decreasing symptoms in the inpatient setting as well as promoting a more successful reentry into the community (Gibson et al, 2011;Nolan et al, 2011). Social skills training has been shown Recovery Model Principles in Inpatient Psychiatric Settings to improve socialization in the community and can be a distinct role for occupational therapists within acute care settings (Gibson et al, 2011;Synovec, 2014).…”

“…Factors, however, that have been found to assist in making a smooth transition from inpatient status into the community include a clear rationale for admission, a time-limited stay, choice of interventions and involvement in a self-management program (Meehan et al, 2002, as cited by Nolan et al, 2011. Nolan et al (2011) also found that at discharge from an inpatient unit, two thirds of consumers interviewed were not confident about their future, questioned their ability to cope, and believed they possessed a lack of knowledge and self-management skills and low self-confidence. Secondary to these findings, occupational therapy in acute psychiatric care should incorporate the recovery model throughout practice to align with evidence-based and consumer-oriented practice, in order to address consumer concerns while admitted.…”

“…Meehan et al (2002) found that without appropriate help, consumers may find the experience of moving between acute inpatient and community services stressful and characterized by loneliness, poor relationships, stigma, unemployment, fear of relapse, and helplessness (as cited by Nolan, Bradley, & Brimblecombe, 2011). Factors, however, that have been found to assist in making a smooth transition from inpatient status into the community include a clear rationale for admission, a time-limited stay, choice of interventions and involvement in a self-management program (Meehan et al, 2002, as cited by Nolan et al, 2011.…”

On the Brink of Genuinely Collaborative Care

“…Radcliffe and Smith (2007) found that only 6% of inpatient service-users' time was spent in therapeutic interaction with staff or activity groups, and Whittington and McLaughlin (2000) found that only 7% of nurses' time was spent in therapeutic interactions. The availability of therapeutic interaction is affected by a number of factors (Nolan, Bradley, & Brimblecombe, 2011), including the loss of skilled staff to better paid jobs in community care, a resulting reliance on bank staff (meaning a reduction in continuity of care), a lack of (psychologically-oriented) staff skills (Samarasekera, 2007), a lack of time to build the relationships necessary for personalized treatment and complex interventions (Yawar, 2008), and a lack of clarity regarding the aims of hospitalization and what constitutes appropriate treatment (Nolan et al, 2011). Our participants, including staff, agreed that hospitalization must better address service-users' needs and adequately prepare them for discharge and recovery to reduce the likelihood of relapse or long-term illness.…”