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Transition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into hospital. There is little research conducted exploring peer support workers’ (PSWs) lived experiences that could provide insight into the key transitions of care, particularly the support required after discharge from inpatient mental health care. The purpose of this paper is thus to provide a particular insight into what it feels like being discharged from psychiatric care from a PSW’s perspective, how may support be improved post-discharge and what factors might impact the potential for readmission into inpatient care.

A qualitative, phenomenological approach was adopted to explore and describe PSWs’ lived experiences of transitioning from psychiatric care. Four PSWs who were employed by a UK secure mental health facility were recruited. PSW is a non-clinical role with their main duty to support patients, and they were considered for this type of the study for their experience in negotiating the discharge process to better carry out their job as a PSW.

After being discharged from psychiatric care, PSWs experienced issues that had either a negative impact on their mental wellbeing or even resulted in their readmission back into inpatient psychiatric care. This study identified three inter-related recurrent themes – continuity of support, having options and realisation, all concerning difficulties in adjusting to independent community life following discharge. The findings of the study highlighted the importance of ensuring that service users should be actively involved in their discharge planning, and the use of effective post-discharge planning processes should be used as a crucial step to avoid readmission.

A deeper insight into the factors that impact on readmission to secure care is needed. The active involvement of service users in effective pre- and post-discharge planning is crucial to avoid readmission.

Mental health professionals should consider developing more effective discharge interventions in collaboration with service users; inpatient services should consider creating more effective post-discharge information care and support packages. Their lived experience empowers PSWs to play a key role in guiding patients in the discharge process.

This is the first study, to the best of the authors’ knowledge, to explore what it feels like being discharged from inpatient mental health care by interviewing PSWs employed at a forensic mental health hospital by adopting a phenomenological approach. This paper offers a deeper insight into the transition process and explores in detail what support is needed post discharge to avoid potential readmission from PSWs’ perspectives.

The concept of inequality refers to being treated unfairly in society and its impact on mental illness has been explored primarily using a quantitative research approach. Patients’ lived experiences of inequalities prior to their admission to a secure care setting need to be addressed with a higher priority as they can serve to improve our understanding of the factors underlying the development of mental illness at a personal level. The aim of this study is to explore participant’s views on whether for them the experience of inequality is associated with the development of mental illness.

A qualitative study, using a thematic analytical approach, was carried out to explore patients’ lived experiences of inequalities. A total of 11 participants, who were receiving treatment in a UK secure mental health hospital, were recruited into this study. The concept of inequality was explored using semi-structured interviews.

Data showed that patients had experienced a variety of inequalities which had negative impact on their mental health. Four main themes were identified from thematic textual analysis – abuse and its impact, a lack of support, the issue of labelling and the importance of understanding.

Data showed that patients had experienced a variety of inequalities which had negative impact on their mental health. Four main themes were identified from thematic textual analysis – abuse and its impact, a lack of support, the issue of labelling and the importance of understanding.

This is the first study, to the best of the authors’ knowledge, to consider intersectionality and admission to mental health units by interviewing patients in secure mental health setting.

Inequalities can have a cumulative effect that leads to the presentation and subsequent progression of mental health difficulties. The detrimental effects can be compounded in the healthcare environment if staff lack an awareness of patients’' inequalities, and therefore, educating staff is of particular importance. The development of awareness training requires a deep understanding of staff perceptions of patient inequalities in a secure mental health care setting and the impact that this can have on mental illness.

The study was carried out using a qualitative design, where staff were asked to complete a 22-question survey from which the output is analysed using thematic analysis. In total, 100 patient-facing staff members working in a secure mental health facility completed the survey.

The results highlight that staff employed in a secure mental health care setting have an understanding of patient inequalities and how these can impact on patients in both the short and longer terms. The results highlighted the importance of awareness by staff and how an increase can have a significant benefit on the quality of the care provided within secure mental health facilities.

There is an increasing awareness of the impact of inequalities on mental health and how this can influence a patient’s journey. This study involving staff employed in a secure care mental health facility highlights the role of staff awareness of inequalities and also underlines the importance of understanding the key role of staff awareness in mental ill health.

The concept of inequality can be described as not being treated equally to everyone else in society. While previous studies have explored the concept of inequality and its impact on mental illness, these have been primarily quantitative. The details of experiences and potential impacts of inequalities by patients prior to admission into secure care have not been investigated comprehensively using a qualitative approach, which will identify individualised factors that may contribute to the development of mental ill-health. This study aims to explore whether those with multiple disadvantages are at greater risk of developing mental illness.

A qualitative study of patients’ clinical notes upon admission to a secure in-patient facility was conducted using a thematic analytical approach to investigate the key inequalities reported by patients with mental health problems. The topic of inequality was examined by assessing the clinical notes of 21 patients who were under treatment at the time of the study.

The majority of patients experienced multiple inequalities which impacted negatively on their mental health status. Three main themes that were identified were – a disrupted living environment, disturbed childhood and the importance of support. The thematic analysis has shown that the majority of the patients were exposed to numerous societal disadvantages in association with challenging life events in their early years and these have impacted significantly on their subsequent well-being.

When assessing the background to mental illness, it is important to gain a deep understanding of many inequalities that patients have faced prior to them developing their condition and, in particular, how these have combined to initiate the clinical manifestation. The study highlights the importance of raising awareness of how being treated unfairly, whether based on protected or non-protected characteristics, can contribute towards people becoming disadvantaged in society and ultimately making them more vulnerable to the development of mental health difficulties. Results of the study may inform the future use of inequalities as an integral component in the development of trauma-informed care.

This is the first study, to the authors’ knowledge, to consider intersectionality and admission to mental health units by adopting qualitative approach, specifically by reviewing patients’ clinical notes.

The COVID-19 pandemic has actively changed the face of all medical disciplines, including mental health practices. In a matter of days from the introduction of the lockdown, clinicians have to adapt to new working models with many changing the consultation methods clinicians have utilized for years. To best understand the wider clinical impact, a limited study was carried out to assess the effect of coronavirus disease 2019 (COVID-19) on psychiatric clinical practice.

A qualitative study was performed to analyze the impact of COVID-19 on clinician practice at a UK secure care mental health facility. A four-question free-text survey was distributed online to all physicians and seven responses were analyzed using thematic analysis.

Four key themes were identified – use of technology, the importance of face-to-face contact, work/life balance and mental well-being.

Overall, the results of the study reported that although some negative changes to the traditional work–life balance were identified, the clinicians found remote working within a secure care setting cultivated a more efficient working environment while allowing for more effective social distance practices.

This study highlighted some of the challenges faced by clinicians employed in a secure care mental health setting following the introduction of lockdown measures in the UK associated with the COVID-19 pandemic. The study will also inform future work practices, including the potential of longer term remote working in this sector.

The more disadvantaged members of society generally experience poorer outcomes following the development of mental ill-health. The purpose of this paper is to scope the literature and synthesise findings on the inequalities and mental health within secure mental health settings.

Six electronic databases were searched to identify relevant studies. These were included if they examined the association between inequalities and mental health in women’s secure mental health settings.

Of the 608 studies reviewed, 14 met the inclusion criteria. In these papers, violence and/or abuse were described as the most prevalent inequalities. The second most frequent group of inequalities identified were socio-economic. Only three published studies researched the impact of ethnicities. Physical health, alcohol abuse and a dysfunctional family upbringing were only mentioned in one of the studies. Gender identity, transitioning and sexual orientation was not considered in any papers. These are areas, which require further investigation to determine their specific impact in this setting.

This review highlights the dearth of high-quality research-based evidence underpinning an understanding of the impact of inequalities on women in secure mental health settings. The existing studies suggest that inequalities have a very particular impact and that intersectionality plays a key role. Further research is required to further understand how inequalities impact the lives of women in secure mental health settings.

The inequalities that women experience in relation to mental health need to be further researched in the context of intersectionality. There are also research gaps in terms of gender identity, sexual orientation and socio-economic background. Further primary research using a more complex methodological paradigm is required to explore these factors and their impact on mental health service provision.

The role of inequalities should be considered as part of an overall care package, including the experiences of adverse childhood experiences and this should contribute towards the development of a trauma-based care approach.

To the best of the authors’ knowledge, this is the first study to scope literature about inequalities experienced in women’s secure psychiatric settings considering intersectionality.

Self-harm is a cause of concern for health-care professionals. The Short-Term Assessment of Risk and Treatability (START) is a short-term assessment instrument used to rate the likelihood of risk behaviours, including self-harm. As result of the assessment, interventions that are implemented to reduce the risk of self-harm may reduce the strength of the predictive validity of a risk assessment tool. The aim of this study was explore the impact of risk management interventions on the capacity of START to predict self-harm. It was predicted that the interventions would weaken the ability of START to predict self-harm in patients who received the intervention.

Secondary analysis of routinely collected data in a large sample of women in an inpatient secure care setting. Demographic and clinical information, self-harm episodes, safety management interventions and START assessments were extracted and used to build an anonymous database.

START significantly predicted self-harm in those with and without the safety management intervention. However, the strength of the predictive validity was smaller in those who received the intervention compared to those without.

The results suggest that the implementation of safety management interventions needs to be taken into account when assessing future risk of self-harm.

To the best of the authors’ knowledge, this is the first study to explore the impact of safety management interventions on the predictive validity of START in a large sample of women.