The Experience of Therapeutic Endings for Low Secure Service Users. V3
Research type
Research Study
Full title
The Experience of Endings for Low Secure Service Users: An Interpretive Phenomenological Analysis. With therapeutic endings encompassing the end of therapy, staff endings and service endings.
IRAS ID
322445
Contact name
Sophie Collingwood
Contact email
Sponsor organisation
University of Southampton
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
1 years, 0 months, 2 days
Research summary
Summary of Research
Secure inpatient settings are hospitals that support people with mental health difficulties under the mental health act, who present as a risk to themselves or others, which requires management in a secure setting. People in secure psychiatric inpatient settings often experience many endings, including therapeutic endings, such as staff leaving the service, patients transitioning between services and ending psychological/other therapy, in which attachment plays a key role
Despite the multiple endings this population may experience, there appears to be a gap in the literature on service user experiences of endings more generally within secure inpatient settings, with most research focusing on ending psychological therapy.This qualitative project aims to interview adults (18+) detained under the Mental Health Act in a Southern Health NHS Foundation Trust low secure hospital, to explore the lived experience of therapeutic endings within a low secure service and explore the meaning that might be given to these experiences. It is hoped that once a better understanding is gained of what might affect a service user’s experience of an ending, that this may support low secure psychiatric hospitals to understand what might help facilitate endings in a purposeful, meaningful way for some service users, which may minimise distress and model more positive endings that this client group may not have had access to (Tapp et al., 2013). Interviews will be analysed using qualitative methods.
Summary of Results
Participants were interviewed about their experience of therapeutic endings, including ending therapy, staff endings, and service or patient endings (i.e. moving ward or from the community to hospital). Interviews were audio recorded and then transcribed. Analysis of 8 transcripts was completed using Interpretative Phenomenological Analysis (IPA). This looks individually at participants experiences, and then looks for patterns across these experiences. As a result of the study, we found there were 3 main themes about how patients experienced endings in the low secure unit where the research took place:
1. 'The Flow of Power' is the first theme. This describes how patients at times felt powerless in their endings, or relationships, and some patients explained how they felt that the Ministry of Justice was an unseen higher power that had control over their ending. Patients seemed to experience staff as a collective, which suggests the ‘us and them’ culture continues in secure care. Patients felt that their relationships came under scrutiny, and some felt disempowered to change these. There was; however, some times were the opposite was true and patients reported feeling as though they had a say in their ending.2. 'Endings Through Time' is the second theme, this depicts the journey patients go on when they experience a therapeutic ending. This theme was broken down into three smaller themes called sub-themes. The first of these ‘Clarity, expectation and (un)certainty)' illustrates the anticipation of an ending, and the feelings this may bring, which for some in the present study meant feeling anxious and uncontained, as they were not sure how the ending might happen or when. Patients described just how important it was for them to have communication about staff endings in particular, and the need to ‘arm’ themselves against the potential emotional impact of an ending. The next sub-theme; 'Marking the Ending', thinks about how the ending is marked, which seemed especially important when staff left. Some patients described how parties and spending one on one time outside the unit was a really valuable way to mark the ending and provide some closure and opportunity for connection and celebration of the relationship. The final sub-theme is about 'New Beginnings' which thinks about what comes next after an ending, four patients thought about how for them, endings are moving onto the next stage, whether this be the community, more work with someone else, or recovery itself.
3. The final main theme is titled ‘Coming to Terms with the Loss of Connection’. It tracks the connection from the beginning through the sub-theme of “Professional Friends”? – Defining the Connection, which speaks to the processing that goes on for participants around what the relationship means to them, before moving on to think about what it means to experience connection and lose it in the sub-theme ‘You Know it was Worth it When it Hurts’. For most participants, this risk is worth the reward, but differences in experience and ways of coping are also discussed.
REC name
North of Scotland Research Ethics Committee 2
REC reference
23/NS/0048
Date of REC Opinion
23 May 2023
REC opinion
Further Information Favourable Opinion