Adverse mental health inpatient experiences: Qualitative systematic review of international literature and development of a conceptual framework

Background Trauma is increasingly linked to poor health outcomes. Adverse experiences in mental health inpatient settings can be traumatic and contribute to long-lasting negative effects like post-traumatic stress disorder. However, the full range of relevant experiences is often unaddressed in service design and delivery. Aim To describe the spectrum of negative experiences that people identify while they are inpatients in adult mental health services. Method A systematic literature review was conducted to identify qualitative studies that included people’s subjective negative reports of their inpatient admissions. CINAHL, MEDLINE and PsycINFO were searched from 2000 onwards, alongside a search of Google Scholar. The quality of studies was assessed using the Critical Appraisal Skills Programme qualitative checklist. Data were synthesised using the ‘best-fit’ framework synthesis approach. A patient and public involvement reference group contributed to the review. Results Studies (111) from 25 countries were included. Adverse mental health inpatient experiences can be conceptualised under three headings: the ecosystem (the physical environment and the resources available, and other people within or influential to that environment); systems (processes and transitions); and the individual (encroachments on autonomy and traumatisation). Conclusions Improved patient experience is associated with improved patient outcomes, and addressing negative experiences could significantly impact patient care. Mental health professionals should strive to create inpatient environments that are supportive, respectful, and safe for patients, which consideration of the adversity framework developed from this review can facilitate.