‘Facing choices’: a mixed-methods approach to patients’ experience of care and discharge in an inpatient mental health unit.

Abstract

Objectives: This thesis addresses patients’ conceptualising of the experience of admission to and discharge from an inpatient mental health unit, and the role of measurable psychosocial constructs in this conceptualisation. Design: An embedded mixed-methods design was employed. Themes developed using thematic analysis were compared and contrasted with standardised assessment ratings. Methods: Twelve adult patients of an acute mental health unit took part in two separate interviews about their experience of admission and discharge, and completed standardised measures of anxiety and depression, social support, attachment style and illness beliefs. Interview data were analysed using social constructionist thematic analysis. Relationships between participants’ contribution to constructed themes and their responses to standardised assessments were discussed in the context of extant literature. Results: A total of fourteen themes were constructed, organised around a central theme of choices, planning and decision making. Many themes were comparable to existing constructs in attachment theory and the literature addressing illness appraisal, including mentalisation, the safe haven, internal working models, self as illness and shame. Standardised assessments supported and enhanced these interpretations. Conclusions: Understanding of the process and adaptation to the inpatient experience can be enhanced by reference to the concepts of attachment theory and social cognition. Incorporation of these concepts into current care practices and future service development may improve the inpatient experience.