The SAFARI study
Research type
Research Study
Full title
An Exploration of the meaning of SAFety for An oldeR adult in a psychiatric Inpatient setting: SAFARI study
IRAS ID
321396
Contact name
Danielle Wilson
Contact email
Sponsor organisation
Canterbury Christ Church University
Duration of Study in the UK
0 years, 8 months, 1 days
Research summary
Older people's psychiatric hospitals provide specialist care for a range of reasons, including challenging behaviour/placement breakdown in dementia, mental health difficulties, deliberate self-harm or suicidal thinking/behaviour. We would like to understand what a psychiatric admission is like for older people, with a key focus on how they experience safety. Safety is a fundamental part of delivering quality healthcare. However, research looking at people’s experiences of psychiatric hospitals found that, while some patients feel safe and cared for, others felt that their admission was neither safe nor therapeutic (Baker, 2000; Glasby & Lester, 2005; Bramesfeld et al., 2007).
We want to focus on older people because, firstly, older people’s mental health is a neglected area of research. For example, Thibaut et al.’s (2019) systematic review of patient safety in inpatient mental health settings identified 364 studies, but only 7 related to older people with mental health difficulties. Secondly, older people are more likely to experience physical health conditions alongside mental health difficulties, and we would like to understand more about the impact of this on their sense of safety. Finally, the COVID-19 pandemic highlighted that older people were more vulnerable to disease, regardless of their overall health. In addition, reports of hospitals refusing to admit care home residents at the height of the pandemic may have left many older people feeling more vulnerable navigating the health system.
The study will involve a one-off interview, lasting about one hour. We will be recruiting from NHS psychiatric wards and older people’s community mental health teams. Anyone over the age of 65, that has been discharged from a psychiatric ward within the past 3 months, will be eligible for the study. People with a cognitive impairment that could impact on their ability to remember their most recent admission will be excluded.
Lay summary of study results:
IPA requires the researcher to interpret what participants say. This means that the researcher attempts to ‘make sense’ of what is being said, even if the participant did not use those exact words.
With IPA, findings are grouped together into themes and sub-themes. Themes refer to the general topics that participants spoke about during their interviews. The sub-themes then reflect the similarities and differences regarding what participants talked about in relation to that theme.
Three themes were developed from the interview data, along with thirteen subthemes. These are summarised below.Fear of the unknown versus learning from experience The first theme that emerge was that participants who had previous experience of an admission were able to draw on their experience to understand and manage their most recent admission. In contrast, participants with no prior experience described how their admission invoked feelings of fear and confusion. This included the admission processes, as well as the rules and procedures, the general ward environment and the routine of the ward.
Exposure to physical threat
A common theme amongst most participants was the presence of physical threat. Many participants considered how vulnerable they or others on the ward might be, but most participants evaluated the perceived level of threat present to be high, regardless of how vulnerable they believed they were.
One of the main strategies for managing this threat was to rely on the presence of staff. However, some participants talked about this being unreliable, and so many adopted personal strategies for coping, which included avoiding particular areas or people.Relational (in)security
Finally, many participants talked about their experiences of safety in relation to relationships. While some participants believed a psychiatric admission could leave them open to the threat of judgement from others, experiencing care (mainly from staff) facilitated feelings of safety.
While some participants had either negative or mixed experiences of care from staff, most talked about how connecting with others, through groups or just getting to know other patients, facilitated safety. For others, compliance and conformity were used as a way of coping with a lack of relational security.Conclusion
The findings from this study suggest that the experiences of safety for older people that were admitted to an older person’s psychiatric inpatient setting are mixed. Participants were active in their pursuit for safety, whilst also being aware of the potentially vulnerable position that they were in. Some participants were able to foster a sense of safety by engaging in practical, cognitive and behavioural strategies, which included finding opportunities to connect with others. However, others described managing by means of compliance and conformity.REC name
West Midlands - Coventry & Warwickshire Research Ethics Committee
REC reference
23/WM/0124
Date of REC Opinion
8 Aug 2023
REC opinion
Further Information Favourable Opinion