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Type: Thesis
Title: Psychiatric inpatient care for children and adolescents: consumer perspectives
Author: Salamone-Violi, Gigetta Maria Luigia
Issue Date: 2017
School/Discipline: School of Psychology
Abstract: Very little published research exists describing the lived experiences of referring clinicians, young people, and parents/carers of young people accessing psychiatric inpatient care. The aim of this qualitative research project is to gain a clearer understanding of the referral process and admission experience from the perspective of the three consumer groups. Identifying similarities and differences between the groups, as well as aspects of experiences with mental health services which were most or least satisfying, may identify consumer specific needs that can in turn, influence continuity in care and contribute to improved mental health. Thirty-one participants comprising nine mental health clinicians, eleven patients of the inpatient unit and eleven parents/carers of young people admitted to the inpatient unit, participated in interviews that lasted between 15 to 109 minutes. The interviews were analysed thematically following the guidelines of Braun and Clarke (2006; 2013). Measures to preserve qualitative rigour were employed from the initial stages of the process, until the writing of the results. Four areas based on the research aims were chosen as a focus for the thesis. Each was the subject of a separate paper: a) a systematic review of the literature on satisfaction around child and adolescent inpatient mental health services, specifically inpatient care; b) the experiences of referrers to the inpatient unit; c) the experiences of young people admitted to the inpatient unit; and d) the experiences of the parents/carers of young people admitted to the inpatient unit. A systematic review of the literature (Paper One) demonstrated the very limited amount of published research focussing primarily on child and adolescent psychiatric inpatient care. The seven quantitative and seven qualitative studies that met the criteria for inclusion (based on Joanna Briggs Institute (JBI) guidelines) demonstrated inconsistencies in methodology and design. They included different sample populations, treatment settings, population characteristics, and measures of outcome. This made generalizability of results difficult to achieve. The review highlighted the need for additional, methodologically rigourous research in this underreported area. Referrers' experiences with referral to and admission of young people in their care to the inpatient unit (Paper Two) identified "safety and risk management" as the overall theme and driving force behind referral to the inpatient unit. The study highlighted the need for inpatient and community-based mental health clinicians to look towards innovative and collaborative service delivery in order to maintain the safety and well being of young people under their care. The experience of young people with mental health services, including referral and admission to the inpatient unit (Paper Three) identified satisfaction as being influenced by a perceived connection with staff and to other patients on the ward. Furthermore, the ability of nursing staff to facilitate feelings of safety, security and acceptance contributed to the young person's desire to remain engaged in treatment post-discharge. To complete the range of user perspectives, Paper Four described the perceptions of carers of young people admitted to the inpatient unit. Carers were universal in their belief that the inpatient unit was the right place for their child. This was on the background of unsatisfactory experiences with community-based care that they perceived as of poorer quality and insufficient to meet their needs. With lack of confidence in community-based services, carers sought treatment post-discharge to be undertaken by the inpatient unit and staff. The findings presented in this thesis may be valuable in the development of strategies for responding to mental illness, particularly in high-risk case scenarios. Increased education, flexibility in service delivery, and greater collaboration between inpatient and community-based services, has the potential to enhance the continuity and consistency in care that mental health services strive to achieve.
Advisor: Chur-Hansen, Anna
Dissertation Note: Thesis (Ph.D.) (Research by Publication) -- University of Adelaide, School of Psychology, 2017.
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