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New study looks at inpatient mental health care across England and Wales

Study found that service users and carers provided many positive accounts in interviews of compassionate, respectful and individualised care


A cross-national study looking at mental health care provision in acute inpatient settings has found that much positive practice is taking place within acute inpatient wards in England and Wales, with evidence of a widespread commitment to safe, respectful, compassionate care underpinned by strong values.

The NIHR report - which is authored by researchers from City, University of London, and Cardiff and Swansea Universities in Wales - found that when wards were seen as focused on the person’s recovery, the quality of care was viewed highly, as was the quality of therapeutic relationships.

It also highlights that while ideas of recovery were evident, there was some uncertainty and discrepancy amongst some staff about the relevance of recovery ideals to inpatient care or the ability of people in acute distress to engage in recovery-focused approaches.

However, service users saw inpatient admissions as important and often necessary stages in stabilising their mental state and perhaps their lives, with medication often an important component.  Staff also spoke of efforts to involve service users and carers in planning care and assessing risk, but the majority did not feel they had been genuinely involved although they were aware of efforts to keep them safe.

Improving the treatment and care of people with mental illness is a key priority in both England and Wales. Despite shifts to community-based care considerable resources are spent on inpatient beds. Annually, around 112,000 people are admitted to mental hospitals, with around 40% of them detained under the Mental Health Act 1983. As a result, considerable planning and coordination is required to ensure effective care is delivered consistently.

To identify factors facilitating or hindering recovery-focused, personalised care planning and coordination in acute inpatient mental health settings, the researchers carried out a cross-national comparative study across 19 mental health hospital wards within four NHS Trusts in England and two Local Health Boards in Wales. This involved surveying 301 service users, 290 ward staff and 28 carers. Interviews were conducted with staff, service users and carers and people’s written care plans were reviewed. Sites were identified to reflect variety in geography, population and setting. The research team also carried out a meta-narrative literature and policy review.

The results build on the research team’s previous community care planning and coordination study to provide a whole systems response to the challenges of providing collaborative, recovery-focused care.

Speaking about the study, Professor Alan Simpson, co-author of the report and a Professor of Collaborative Mental Health Nursing in the School of Health Sciences at City, said

“Our study found that service users and carers provided many positive accounts in interviews of compassionate, respectful and individualised care being provided and of specific attempts to keep patients safe. However, it also highlighted several areas which we can improve, including ideas around ideas of recovery and the involvement of service users and carers. As a result, in future work we hope to investigate approaches that increase contact time with service users and also promote personalised, recovery-focused working, while also introducing share decision-making in risk assessment and management. This should help improve service user experiences and ensure they receive the appropriate care they need.”

This study has been commissioned by the National Institute of Health Research, Health Services and Delivery Research (HS&DR Project: 13/10/75) who had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Views and opinions expressed are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.

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