Psychiatric inpatient care for children and adolescents: consumer perspectives
Date
2017
Authors
Salamone-Violi, Gigetta Maria Luigia
Editors
Advisors
Chur-Hansen, Anna
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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.
School/Discipline
School of Psychology
Dissertation Note
Thesis (Ph.D.) (Research by Publication) -- University of Adelaide, School of Psychology, 2017.
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