Adverse mental health inpatient experiences: Qualitative systematic review of international literature

Background

Trauma has a well-established link with poor health outcomes. Adverse experiences in mental health inpatient settings contribute to such outcomes and should impact service design and delivery. However, there is often a failure to fully address these experiences.

Objective

To describe the spectrum of negative experiences that people identify while they are inpatients in adult mental health services.

Design

Qualitative systematic review of the international literature.

Setting(s)

Inpatient mental health settings globally.

Participants

Analysis includes findings from 111 studies across 25 countries.

Methods

CINAHL, MEDLINE and PsycINFO were searched from 2000 onwards, supplemented by Google Scholar. Studies were appraised using the Critical Appraisal Skills Programme qualitative checklist. Data were synthesised using the ‘best-fit’ framework synthesis approach, enriched by patient and public involvement.

Results

Adverse mental health inpatient experiences can be conceptualised under three headings: the ecosystem (the physical environment and the resources available, and other people within or influential to that environment); systems (processes and transitions); and the individual (encroachments on autonomy and traumatisation).

Conclusions

This paper highlights the interplay between systemic, environmental and individual factors contributing to adverse experiences in mental health inpatient settings. By recognising and addressing these factors, we can significantly enhance patient outcomes. Application of adversity to Bronfenbrenner’s ecological systems theory provides a strategic approach to improving service design and delivery, advocating for environments that prioritise patient safety, dignity and respect. However, further research is needed to validate the framework and effectively integrate these insights into practice, ultimately transforming the inpatient care experience for all stakeholders.

Registration

The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022323237).

Tweetable abstract

Review suggests traumatic experiences in mental health inpatient settings can worsen outcomes. Urges redesign of environment, processes and autonomy to improve care @dr_nutmeg @EmxEn @RAVresearchUoB @IMH_UoB