Research and commentary

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

A study of 20 young people who had experienced psychiatric units in the UK formed the basis towards understanding adolescent views of inpatient settings.

A study of 20 young people who had experienced psychiatric units in the UK, formed the basis towards understanding adolescent views of inpatient settings.


Picture: iStock

Reavey P, Poole J, Corrigall R et al (2017) The ward as emotional ecology: Adolescent experiences of managing mental health and distress in psychiatric inpatient settings. Health & Place. 46, 210-218.

Aim

This study was to gain an understanding of adolescents’ experiences of an inpatient mental health environment, with a particular focus on their relationships with people and with the place itself.

Methods

Face to face interviews, using photographs of the environment as visual prompts, were used to collect data from 20 young people (14-18 years of age) who had experiences of psychiatric units in the UK. Interviews were conducted six months after the young people had been discharged from the inpatient service. The researchers excluded young people who had a profound intellectual disability or could not communicate fluently in English.

Findings

The young people reported that the inpatient ward environment seemed unequipped to deal with their traumatic experiences and emotional trauma, which is often the purpose of an admission, and they felt that a shorter period of admission would have been more useful for their recovery.

Some young people reported that they felt the need to escalate their behaviour in order to communicate their internally experienced emotions to staff. Feelings of disconnection from the reality of regular life were experienced, as a consequence of spending time in the ‘unnatural’ environment, young people felt fearful of becoming ‘too settled’ in a place which was frequently described meephorically as ‘zoo’ and ‘holiday camp’. These challenges were balanced against the young people witnessing and experiencing caring, listening and empathising behaviours from staff. The young people in this study deemed it meaningful when staff engaged in ‘ordinary’ unscheduled activities with them, such as playing games or engaging in general conversation.

Conclusion

This research concludes that young people can experience additional and unnecessary distress during an admission to a child and adolescent mental health services (CAMHS) inpatient unit as a result of the environment, the behaviour of other inpatients and the lack of ‘everyday’ informal type interactions with staff.

Young people describe a negative experience of an inpatient mental health unit

This study highlights the importance of relationships, emotional fragility and the lasting impact of being in an inpatient mental health unit can have upon a young person.

Building relationships between staff and patients, and providing a safe environment should be key elements of all therapeutic inpatient mental health services.

However, many of the young people in this study describe the inpatient environment as feeling like a ‘holding place’ to contain behaviour rather than treat mental health issues.

For some, the environment and constant feeling of being observed became confusing and led to coping strategies that disconnected their ‘feelings’ from their ‘behaviours’.

It is powerful that every participant in this study perceived the inpatient environment as an inappropriate space to receive treatment for their mental health condition.

It must be acknowledged that this study only involved a small number of adolescents from one UK locality, although several of the young people had experienced and reported on their admissions to the NHS and independently operated adolescent units.

Where staff have provided ‘care and safety’ some of the young people in this study report ‘constraint and containment’, perspectives which are retained long after their discharge from the service.

There are many compassionate professionals in inpatient mental health services who strive to deliver high-quality care and it takes time, training and experience to develop the therapeutic relationships required to approach complex emotional issues often experienced on an inpatient mental health unit.

It seems that for the young people in this study, the therapeutic interventions were sometimes overshadowed by a perceived lack of ‘everyday’ informal contact; they reported that their most treasured moments of an inpatient stay were when they ‘felt like they mattered to someone’.


Compiled by Simon Nielson mental health nurse, PhD student and graduate teaching assistant, faculty of health and social care at Edge Hill University in Ormskirk. For and on behalf of the RCN’s Research in Child Health community.

This article is for subscribers only

Jobs