The therapeutic needs of psychiatric in-patients with psychosis: A qualitative exploration of patient and staff perspectives

Abstract

Background Concerns are recurrently expressed that the therapeutic content of in-patient care is limited and lacking clear guidance. The perspectives of patients and staff regarding therapeutic priorities for psychiatric in-patient care have been little explored and compared. Aims The aim of this study was to examine patient and staff perspectives on the care priorities of psychiatric in-patients with psychosis. Method We recruited 12 in-patients with psychosis and 12 multidisciplinary team staff. All participants undertook a semi-structured interview examining their perspectives on the therapeutic needs of people with psychosis during admission. Interviews were transcribed verbatim and thematic analysis conducted. Results Three superordinate themes arose from patient interviews: ‘the importance of considering social circumstances and trauma’, ‘managing the intra- and interpersonal impact of psychosis’ and ‘lack of control and collaboration in care’ and three from staff interviews: ‘multidisciplinary facilitators of care’, ‘treating complexity and incorporating social factors’ and ‘restrictive practices preventing quality care provision’. Comparison of patient and staff themes identified unmet needs in addressing social marginalisation, trauma and distress, and the importance of collaborative treatment process and inclusion of spirituality. Conclusions There are gaps between staff and patient perspectives on important priorities for in-patient care that may help explain persistent patient dissatisfaction with in-patient care. Findings suggest the need for coproduced work to develop and test interventions that address broader therapeutic priorities. Declaration of interest None.

A systematic review and meta-analysis of cognitive behavioural informed psychological interventions for psychiatric inpatients with psychosis

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Virtual Reality Cognitive Therapy in Inpatient Psychiatric Wards: Protocol for a Qualitative Investigation of Staff and Patient Views Across Multiple National Health Service Sites (Preprint)

“…Pressures are compounded by the limited availability of trained staff [12], a reliance on agency staff, and high levels of staff burnout [13]. Therefore, opportunities for staff-patient engagement in therapeutic relationships and collaborative care focused on recovery are limited [9,14]. Delivery of one-to-one or group psychological therapy is infrequent [15], with wards having very limited input from qualified psychologists [16] and treatment being predominantly pharmacological [12].…”