In and Out Project update

In and Out: People with lived experience, carer and professional perspectives on avoiding admission to mental health hospitals, and how discharges could be safely made more quickly 

In Spring 2022, Surrey Coalition of Disabled People (The Coalition) was asked to undertake a research project to better understand: 

• What support could help individuals, their families and carers to safely avoid an unnecessary admission to hospital for a mental health crisis 

• What support could enable people to get well more quickly and for admissions to be shorter 

• How discharge arrangements could be improved 

Data Collection 

The In and Out Surveys ran for 30 days. One survey was aimed at people with lived experience of admission and carers, and the other survey was aimed at mental health professionals. At the end of the survey, participants could register their interest in a follow-up interview with the researchers. 

The research team conducted semi-structured interviews online, by phone and in person. They also hosted two pop-up events to engage with more people in the community. One was held at a local mental health hospital and one was held at a supported living facility in Surrey.  

In total, 31 people completed the survey, and 17 people were interviewed. 

Data Analysis 

The data was made up of survey responses and transcripts of the interviews. The researchers applied a SEIPs (Safety Engineering Initiative for Patient Safety) approach, and then a thematic analysis to the data. The SEIPS approach involved picking out data which related to certain areas such as physical environment and organisation. The thematic analysis involved identifying similarities across the data and bringing them together under themes. These can be viewed within the animation about this project: Research blogs – Surrey Coalition of Disabled People and the full report will be available soon and uploaded to our website.

“Analysis involves a constant moving back and forward between the entire data set, the coded extracts of data that you are analysing, and the analysis of the data that you are producing.” —Virginia Braun and Victoria Clarke, Researchers 

As well as the themes which were identified, the research team highlighted five overarching areas within the data: 

Findings 

1. What support helps to safely avoid an admission to hospital for a mental health crisis 

“I didn’t find them [community service] particularly helpful, … It’s just when you ring, the person who’s assessing you is probably less experienced than the person I’m used to dealing with when I have problems so I spent a long time talking through things for them to then say I need to escalate this to the next level, which I knew would be the case. So I didn’t go … in the end, but for me it just for me it created more of a tier of complexity ’cause when I’m like that, I need more than what that junior person can offer.” – Person with lived experience 

2. How new mental health conditions can be managed better at home 

“For intensive therapy, waiting lists are long and opportunities are small.”- Professional & person with lived experience 

3. How known mental health conditions can be managed better at home 

“Our daughter, like many with her illness, does not know when she is ill which results in her not taking medication.”- Carer 

4. What helps people get well more quickly and have shorter stays in hospital 

“These places aren’t very pleasant, you know, and people don’t like being there and they’re very risk averse. They’re not a natural environment. As I say, we feel policed on the ward. We don’t feel nursed and so it’s about containment” – Person with lived experience 

My room at the mental health hospital “was ok but it didn’t feel very private. The toilet and the shower bit – because it only had these – you know saloon doors you get on an Old styled Western? It was like those and anyone, staff could just walk in. This is going to sound terrible! I didn’t have a shower in the two weeks I was there because I felt too exposed and embarrassed to have one because of those flimsy little doors. All I did was have a wash every day at the sink quickly – as fast as I could.” – Person with lived experience 

5. How discharge arrangements could be improved 

“I remember getting a taxi to my flat. I remember feeling a drift in my flat and not really knowing what to do. I didn’t know when I would see a care co-ordinator and I was just waiting for a call.” – Person with lived experience 

There is scope for recommendations to be made to relevant services about how to address issues which participants raised around admission, discharge, and mental health care in Surrey. We will shortly be following up with system partners to formulate recommendations out of this research to create change.  

For the executive summary and animation, please visit: Research blogs – Surrey Coalition of Disabled People. The full report will be available soon and uploaded to our website.