Studying recovering on a rehabilitation ward
Research type
Research Study
Full title
An ethnographic study of treatment and recovery on an inpatient mental health rehabilitation ward
IRAS ID
314971
Contact name
Helen Killaspy
Contact email
Sponsor organisation
Camden and Islington NHS Foundation Trust
Duration of Study in the UK
0 years, 11 months, 30 days
Research summary
One in five people who are diagnosed with a severe mental illness, such as schizophrenia, develop long-term difficulties. These difficulties might include problems with looking after themselves or engaging with others. Such problems usually arise because the person has persistent symptoms of mental illness (e.g., hearing voices) despite treatment, often alongside issues such as substance use or poor physical health. We refer to these most severe forms of mental illness as ‘complex psychosis’.
Clinical guidelines recommend that people with complex psychosis receive treatment from mental health rehabilitation services. These services are designed to support ‘recovery’. Recovery refers to the idea that people with mental illness should be able to decide how they want to live their own lives, what their hopes for the future are, and what support they need.
Recovery-based rehabilitation services are effective at enabling people to live more independently. But we know very little about what people with complex psychosis think of rehabilitation services, how they understand and experience recovery, and what they find helpful or unhelpful. Given that many NHS trusts are currently lacking rehabilitation services, it is important that we understand how people with complex psychosis actually experience recovery in these services.
This study aims to investigate in detail how people with complex psychosis receiving care from inpatient rehabilitation services in north London understand and experience recovery; and how the rehabilitation services support their recoveries. To understand these things, the Principal Investigator will immerse himself in the daily routines of service users and staff on an inpatient rehabilitation ward over 6 months. He will spend his time ‘hanging out’ in communal areas, talking to service users and staff, taking detailed notes, conducting interviews, and using art to stimulate discussion, to build up a detailed picture of recovery and treatment on the ward.
LAY SUMMARY OF STUDY RESULTS:
There were two important results from the study.
The first result is that we were able to understand what helps people with complex psychosis to recover on an inpatient rehabilitation ward. We found that good relationships between staff and patients were very important for this. These relationships had to be built and maintained by staff. They involved genuine human connection, attention to detail, and appreciation for the slow progress of patients. However staff could often not spend as much time with patients as they wanted. This was for a few reasons. For example, other things like risk management seemed to be more valued by the hospital and the NHS trust. Also, staff often had to interact with patients through very standardised processes that prevented human connections. Finally, staff often felt demotivated, because they did not feel valued or supported in their work. These things stopped the relationships between staff and patients on the ward being as helpful as they might have been.
The second result is that we were able to understand how some people's recoveries from complex psychosis might look a bit different from recovery in other mental health conditions. For example, as they recovered, some of the patients became wary of socialising with people, or of revealing their true beliefs and identity, or of getting too hopeful. Doing these things is normally thought to be really important in recovery, but some of the study participants felt calmer and happier when they stayed away from these things. This probably happened for a couple of reasons. It probably reflects how stigmatised people with complex psychosis are in wider society. It also probably reflects how complex their illnesses are. Even though many of the participants did not like being detained on the rehabilitation ward, many also acknowledged the ward as a safe place where they had the time and space to work out how they could recover in their own unique way.
REC name
West Midlands - Coventry & Warwickshire Research Ethics Committee
REC reference
22/WM/0154
Date of REC Opinion
12 Aug 2022
REC opinion
Further Information Favourable Opinion