How clinical psychologists experience working in an acute mental health inpatient setting

Abstract

The focus of this study was to explore how Clinical Psychologists narrate their experience of working on acute adult inpatient units. Mental health services in the UK are poorly resourced with treatments dominated by medical model perspectives. This model can conflict with the psychological and social models Clinical Psychologists are trained in. The aims of this study were to explore the experience of Clinical Psychologists working in acute adult inpatient units and, through this, develop insight into how the core values for improving inpatient care could be maintained.

This study was guided by Social Constructionist principles. It required a critical stance to be applied on the current system with an understanding that knowledge is co-constructed between and within relationships. Eight individual semi-structured interviews with Clinical Psychologists who work on adult acute inpatient units were conducted and explored using Narrative Analysis. Four dominant narratives were found. These were; ‘You can’t beat the system’, ‘I am screaming’, ‘Connecting with humanity’ and ‘Someone is screaming’. These narratives related to the Clinical Psychologists themselves in conjunction with the system they were working in which included staff, patients, myself as the interviewer and society in general with the understanding that the interviews were co-constructed and represented multiple voices. This research confirmed that cuts and lack of resources to NHS services have created a massive strain on the system. The Clinical Psychologists working in this system are attempting to understand and support individuals in acute distress; however, they appear to be doing this in isolation which puts them in danger of burn out. It would seem the system is organised against thinking and feeling, affecting both staff and patients, and leaving their experiences unheard and invalidated. The people who are admitted to wards are likely to have had abusive and invalidating earlier experiences. Wards need to be a safe place where they can have time to express themselves, process this and experience validation. The opposite seems to be happening, thus, potentially perpetuating their experience of abuse and neglect. Compassion is a Government directive, yet it takes time and space and, thus, is not cost-efficient. To achieve a system, where people who are vulnerable can express their distress and feel heard, provision of ongoing support and resources is required.

Further research could explore the experience of staff who work on inpatient units, for instance health care assistants, nurses, psychiatrists and managers in order to provide further insight into the system that is currently in place and help to develop ways to improve it. It would also give voice to professions that did not have a voice in this research. Experiences of Clinical Psychologists on inpatient units where the medical model is not dominant could also be explored, for instance, where the Open Dialogue approach is dominant. Comparisons between the different approaches could then be explored.