The ward as emotional ecology: Adolescent experiences of managing mental health and distress in psychiatric inpatient settings

Abstract

Previous research on young people's satisfaction of inpatient services has often relied on the responses of carers and relevant practitioners. It is difficult to ascertain to what extent such reporting accurately represents the satisfaction levels of young people, with emerging research suggesting wide discrepancies. As part of a wider study evaluating the effectiveness of a Supported Discharge Service (SDS) operating within South London & Maudsley NHS Foundation Trust, this paper examines how young people experience inpatient services, on a social and emotional level. Twenty young people, (10 SDS and 10 TAU) participated in a semi-structured visual-interview study to examine their experiences of admission, ward-life and treatment. A thematic decomposition analysis was conducted on the data and specific themes relevant to satisfaction and engagement with inpatient services was examined in-depth. These include a) Behavioural surveillance as care surrogate and b) Managing the delicate emotional ecology of the ward: openness, triggering, sterility and relational engagements. Finally, we explore some of the implications of these inpatient experiences for supported discharge services.

How Young Adults in London Experience the Clubhouse Model of Mental Health Recovery: A Thematic Analysis

“…It seemed that when she wanted to be listened to, she was thoroughly questioned instead. As in Reavey et el's research, which looked at experiences in inpatient care, Ali seemed to quickly pick up on the unyielding emphasis on risk management within hospitals, and also felt that her emotions needed to be contained within those settings (25). With regard to crisis services, which she intensely disliked, the clubhouse offered her a preferred solution.…”

“…Norman conducted a qualitative study in which three main thematic items were identified: meaningful relationships, important work tasks and a supportive environment. Reavey and colleagues (25) conducted research regarding inpatient experiences within a Supported Discharge Service in a London borough, making it very valuable in terms of comparison and context. Young people described hospital wards as places to contain behaviour, rather than as places to treat and deeply explore mental health difficulties.…”

Understanding the nature of mental health nursing within CAMHS PICU: 1. Identifying nursing interventions that contribute to the recovery journey of young people

“…Content analysis has been shown to be a relevant and effective qualitative research methodology in the field of nursing, as a systematic means of describing phenomena and establishing relational links between concepts. Inductive methods of content analysis in which data is analysed through a theoretical lens to support understanding and meaning-making are particularly indicated to build up a conceptual system or enhance understanding when there is insufficient pre-existing knowledge of the issue (Elo & Kyngäs 2007;Reavey et al 2017). The study was conducted in one 10-bed mixed gender CAMHS PICU in the North of England.…”

Nursing in child psychiatric milieus: What nurses do: An update

“…These issues heighten with adolescents, who owing to their developmental stage value their autonomy, but are now in a position of even tighter adult controls. In discussing hospitalizations, adolescents told researchers that when the unit focus is limit setting on overt behaviors, staff often fail to see and respond to their underlying distress (Reavey et al., ). Thus, an element of support is the balance staff reaches between their need to maintain control over the tone and pace of the milieu and adolescents’ need for autonomy.…”