The Feasibility of Outdoor Psychology Sessions in an Adult Mental Health Inpatient Rehabilitation Unit: Service User and Psychologist Perspectives.

Few studies have explored outdoor therapy when facilitated by clinical psychologists within an inpatient mental health service. In the present study, outdoor psychology sessions were introduced after service users (SUs) expressed a desire to return to face-to-face working during the COVID-19 pandemic. This study aimed to explore SUs' and clinical psychologists' perspectives on the feasibility of conducting outdoor therapy within the service. A mixed-method approach was underpinned by critical realist philosophy. Three psychologists maintained reflective diaries following outdoor therapy sessions with 16 SUs. A subsample of 14 SUs completed scales measuring therapeutic alliance and comfort during outdoor sessions. A subsample of eight SUs participated in semi-structured interviews. Data was analysed using descriptive statistics and thematic analysis. Quantitative and qualitative data demonstrated high SU satisfaction with therapeutic alliance and comfort outdoors. Six themes were identified: utilising a person-centred approach; the value of multi-disciplinary team support; enhancing therapeutic engagement; the benefits of time away from the ward; managing confidentiality; physical health and safety. This feasibility study demonstrated the introduction of outdoor psychology sessions within an inpatient mental health service to be a viable response to COVID-19. The findings suggest outdoor therapy can be an effective and safe mode of therapy, and can offset the challenges of indoor working, providing certain risk factors are considered and managed. The limitations of this study and implications for clinical practice are discussed. Further research is now required to support future integration into clinical practice.

The experiences of inpatient nursing staff caring for young people with early psychosis.

BACKGROUND: Early intervention services aim to improve outcomes for people with first episode psychosis and, where possible, to prevent psychiatric hospital admission. When hospitalisation does occur, inpatient staff are required to support patients and families who may be less familiar with services, uncertain about possible outcomes, and may be experiencing a psychiatric hospital for the first time. AIMS: Our study aimed to understand the process of hospitalisation in early psychosis, from the perspective of inpatient nursing staff. We were particularly interested in their experiences of working with younger people in the context of adult psychiatric wards. METHODS: Nine inpatient nursing staff took part in semi-structured interviews, which were transcribed and then analysed using interpretative phenomenological analysis. RESULTS: Five themes are outlined: 'it's all new and it's all learning'; the threatening, unpredictable environment; care and conflict within the intergenerational relationship; motivation and hope; and coping and self-preservation. CONCLUSIONS: The phenomenological focus of our approach throws the relational component of psychiatric nursing into sharp relief. We reflect on the implications for organisations, staff, families and young people. We suggest that the conventional mode of delivering acute psychiatric inpatient care is not likely to support the best relational and therapeutic outcomes.

The experiential impact of hospitalisation: Parents' accounts of caring for young people with early psychosis.

This research examines the experiential impact of hospitalisation on the parents of young people with early psychosis. In-depth interviews were conducted with a small sample of parents, and the resulting transcripts were analysed using Interpretative Phenomenological Analysis. Five themes emerged from the data: Accepting and blaming, Feeling out of control, Hospitalisation as temporary containment, Feeling let down by services and Stigma. Aspects of the hospitalisation process were characterised by parents as generally negative, but a number of positive affirmations were also offered regarding the containing, supportive and crucial role of services. Parents' perceptions of hospitalisation as a difficult, and sometimes distressing, experience are exacerbated by the complexity of being the carer of a young person. Negotiating services and boundaries within the context of this relationship contributes to feelings of exclusion and disregard by professionals and services. The implications of this study resonate with the current government mental health strategy with regard to how services can engage and include carers in the mental health system, and equip and enable them to support their relatives with early psychosis.

The experiential impact of hospitalisation in early psychosis: service-user accounts of inpatient environments.

Early Intervention in Psychosis services aim to keep young people out of hospital, but this is not always possible. This research used in-depth interviews to explore the experience of hospitalisation amongst young people with psychosis. Findings describe fear and confusion at admission, conflicting experiences of the inpatient unit as both safe and containing, and unsafe and chaotic, and the difficult process of maintaining identity in light of the admission. We discuss the need to move from construing psychiatric hospitals as places for 'passive seclusion', to developing more permeable and welcoming environments that can play an active role in recovery.