Understanding Individual's Experience of the Revolving Door Phenomenon
Research type
Research Study
Full title
Understanding Individual’s Experiences of Multiple Mental Health-related Hospital Readmissions: A Thematic Analysis of the ‘Revolving Door Phenomenon’
IRAS ID
333474
Contact name
Sanaa Kadir
Contact email
Sponsor organisation
University of Leicester
Duration of Study in the UK
1 years, 2 months, 1 days
Research summary
Summary of Research
This research aims to understand the experience of individuals who have had multiple mental health-related hospital readmissions, known as the revolving door phenomenon. Research has found that this readmission cycle can have a significant impact on the individual and their social systems, by increasing loneliness, shame and distress. Additionally, this has an impact on services as these individuals are found to use a disproportionate amount of service resources.
This qualitative research project will use semi-structured interviews to gain an understanding of individuals’ beliefs about the reasons that they have experienced multiple readmissions, what support they have found helpful and unhelpful (in the community and in hospital), and what impact this readmission cycle has had on their life. It is hoped that by understanding this phenomenon from the perspective of the individual at the centre of it, this could inform changes to services to reduce hospital readmissions, which could improve individuals’ and their families’ quality of life, reduce mental health distress and address service resource pressures.
We aim to recruit 15-20 participants. Participants must be over 18 years old and have had three or more mental health-related hospital admissions in their life, as this is what the research classifies as the revolving door phenomenon. This excludes admissions for physical health or forensic behaviour. Individuals who are currently in hospital and the community will both be included because perspectives may differ based on current hospitalisation status. Individuals will be recruited through opportunity sampling across Adult Mental Health services in Leicestershire Partnership Trust where eligible people are likely referred.
Participants will be asked to take part in an individual interview lasting between 30 minutes to 1 hour. The interview will be conducted face-to-face, by telephone or video call depending on the participant’s preference. Qualitative data from the interview will be analysed using reflexive thematic analysis.
Summary of Results
What did we do?
We spoke to 15 people who had experienced multiple mental health related hospital admissions (at least 3 or more).We asked them about their experiences of multiple readmissions, what they thought the reasons for their admissions were, what they found helpful or unhelpful about services, and what impact readmissions had on their lives.
We recorded what they said and analysed it using a method called “reflexive thematic analysis”. This means we looked at what each person said and noticed any themes or patterns, to see what people’s experiences of multiple readmissions was and if people shared similar or different experiences.
We hoped this would help to understand this experience more, so that we can help reduce readmissions by making positive changes to services.
What did we find?
We found five themes shown in the diagram below, called a “thematic map” [unable to insert graphic]. This showed that Some people felt services had failed them, suggesting hospital and community teams didn’t given them the right support, otherwise their admissions could have been prevented.
They thought discharges were unhelpful, often being discharged too soon and without the right support ready for them in the community.
Some participants felt services were supportive and admissions were necessary, offering safety in hospital when they don’t feel safe in the community.
Sometimes people would blame themselves for the multiple readmissions because they feel services did everything they could, but they still continue to be readmitted.
This led to a theme recognising that every experience is different, with differences between services, between each admission and between different people.
People had experienced various difficulties, such as trauma, social isolation and housing problems, which they felt often caused admissions, but also were made worse by admissions. This showed how the RD phenomenon is a vicious cycle.
Some participants felt hope for recovery and could identify things that would help, like having someone to talk to, understanding their mental health better and having meaningful things to do.What does it mean?
These findings suggest that some ways services could improve are:
Increase access to psychological and occupational therapy support e.g., use psychological formulation to help people better understand their mental health.
Improve discharge processes, make sure care in the community is planned and ready before they are discharged.
Involve people in decision making about their care, listen to them and respect their views.
Address problems in the community like unstable housing and why people might feel unsafe in the community.
Continue positive relationships between patients and staff in hospital so that patients have someone to talk to and feel emotionally supported. Further research is needed still to find out… What do friends and family think? What do staff think could help?Contact for Further Information
For further information about the study, please contact Sophie Hodges (sh941@leicester.ac.uk)REC name
Social Care REC
REC reference
24/IEC08/0010
Date of REC Opinion
3 May 2024
REC opinion
Further Information Favourable Opinion