Exploring patient safety factors in mental health care transitions V1
Research type
Research Study
Full title
An interview study exploring the factors that keep service-users safe during the transition from acute adult inpatient mental health care to community, from a service-user and carer perspective.
IRAS ID
327058
Contact name
Jessica Rich
Contact email
Sponsor organisation
University of Leeds
Duration of Study in the UK
0 years, 7 months, 1 days
Research summary
Summary of Research
The transition between being a service-user on an acute mental health ward and returning to the community can be a challenging and unsafe time for service-users. A large number of incidents, including suicide and service-users returning to hospital, are more likely to happen within the first 30 days of leaving hospital. There are very few studies which have looked at service-user views about what keeps them safe during this transition. This interview-based study will explore the factors which keep service user’s safe when leaving an acute mental health ward, through interviews with working-age (18-65 years) service-users and carers who have experienced this transition.
We will recruit for interviews through (1) advertisements via third sector services (e.g., Carer Leeds), and (2) Care Coordinators at NHS trusts who will identify people and give information to those who they think are appropriate for interview. The interviews will take place either online, over the telephone or face-to-face depending on participant preference. If the interview is face-to-face, it will be at a public place where both the participant and interviewer feel safe and comfortable (e.g., community centre). The interview will take 1 hour. Following the interviews, we will use the findings to guide the development of a patient safety measure.Summary of Results
We spoke to 16 service users with recent experience of inpatient mental health care and 2 carers of service users about their experiences of safety when moving from acute inpatient mental health care to community settings. The research team identified four key themes which all have two subthemes.
Theme One: “Disconnects in the transition period, from separate systems to contrasting environments”. The first part of this theme is about service user and carer experiences of hospitals, community services, and general healthcare not working well together. This caused problems and delays in service users accessing support after leaving hospital. Teams not working well together was worse for service users who were discharged from private hospitals or hospitals that were not local to where people lived.
“ ‘You're not in the right area. You need to see the [place] team.’ You’re just passed from person to person saying we don't do that. You can't do that” [Anya, service-user].
The second part of this theme is about the challenges service users face when readjusting to living in the community after being on a hospital ward surrounded by lots of people and 24-hour care. Service-users discussed the difficulties of regaining daily living skills (for example, cooking), caring for themselves, and resuming responsibilities (for example, caring for relatives). Carers of service users returning to community settings also found it difficult to support the safety of service users in the community without any support. Both service users and carers felt stable and safe housing was essential to support the safety of service users after leaving hospital.
Theme Two: “Complexities of the inpatient environment and its impact on timely discharge”.
The first part of this theme is about how the timing of discharge affected the safety of service users. Some service-users described feeling stranded on the wards. They described the environment being chaotic and overwhelming but were too unwell to leave. Other service-users felt they were discharged when they were not psychologically ready to leave hospital. This made it harder for them to stay safe and feel safe in the community, with some service users having to return to hospital soon after discharge. Some service users spoke about their discharge being delayed, which made them feel stuck on the ward and felt it slowed their recovery.
The second part of this theme is about unexpected changes to decisions about discharge. This includes some service users being discharged without warning, which caused them to feel distressed and unprepared to leave.
“I was more worried that starting things off, in a kind of chaotic way, would make it much harder to adjust generally, and that could then impact how I was feeling.” [Henry, service-user]Theme Three: “Firefighting versus preventative care”.
The first part of this theme is about service users who were only given post-discharge support once they reached a crisis point and were often directed to attend emergency departments. However, service users felt that emergency departments are not appropriately equipped for providing mental health support.
“If you need help… it’s not enough to be in crisis, you need to be beyond crisis” [Zara, service-user] The second part of this theme is about how creating and putting in place meaningful discharge and safety plans before leaving hospital are important for effective monitoring and to prevent crisis. Receiving support from family and charities were also viewed as essential to help service users stay safe in the first few days after discharge.
Theme Four: “Being understood”.
The first part of this theme highlights the importance for service users to be empowered and involved in decisions about their care. Some service users discussed positive experiences of working with professionals to develop personalised discharge and safety plans. However, other service users felt they were excluded from decisions and did not have the opportunity to be involved.
“I've had mental health issues for a fair while now, so I kind of feel like I've got like a good understanding of what sort of works for me and like what sort of being in a crisis might look like sort of thing so I know that the warning signs and stuff” [Aidan, service-user] The second part of this theme is about the importance of developing supportive and trusting relationships between service users and professionals. This allowed service users to feel more comfortable in being open and honest about how they were feeling during the move to community care and readjusting to living back in the community. Seeing different staff at each appointment and inaccurate reports impacted service users’ trust in the system and the ability to build these relationships.REC name
South East Scotland REC 01
REC reference
23/SS/0080
Date of REC Opinion
12 Jul 2023
REC opinion
Favourable Opinion