Skip to main content Accessibility help

Life in acute mental health settings: experiences and perceptions of service users and nurses

  • D. Rose (a1), J. Evans (a1), C. Laker (a1) and T. Wykes (a2)



Acute psychiatric provision in the UK today as well as globally has many critics including service users and nurses.


Four focus groups, each meeting twice, were held separately for service users and nurses. The analysis was not purely inductive but driven by concerns with the social position of marginalised groups – both patients and staff.


The main themes were nurse/patient interaction and coercion. Service users and nurses conceptualised these differently. Service users found nurses inaccessible and uncaring, whereas nurses also felt powerless because their working life was dominated by administration. Nurses saw coercive situations as a reasonable response to factors ‘internal’ to the patient whereas for service users they were driven to extreme behaviour by the environment of the ward and coercive interventions were unnecessary and heavy handed.


This study sheds new light on living and working in acute mental health settings today by comparing the perceptions of service users and nurses and deploying service user and nurse researchers. The intention is to promote better practice by providing a window on the perceptions of both groups.


Corresponding author

* Address for correspondence: Dr Diana Rose, Institute of Psychiatry, King's College London, De Crespigny Park, PO 34, London SE5 8AF, UK. (Email:


Hide All
Austin, W, Bergum, V, Goldberg, L (2003). Unable to answer the call of our patients: mental health nurses' experience of moral distress. Nursing Inquiry 10, 177183.
Bowers, L, Crowhurst, N, Alexander, J, Callaghan, P, Eales, S, Guy, S (2002). Safety and security policies on psychiatric acute admission wards: results from a London-wide survey. Journal of Psychiatric and Mental Health Nursing 9, 427433.
Cleary, M, Edwards, C (1999). ‘Something always comes up’: nurse–patient interaction in an acute psychiatric setting. Journal of Psychiatric and Mental Health Nursing 6, 469477.
Cornwall, A, Jewkes, R (1995). What is participatory research? Social Science and Medicine 41, 16671676.
Evans, J, Rose, D, Flach, C, Csipke, E, Glossop, H, McCrone, P, Craig, T, Wykes, T (2012). VOICE: developing a new measure of service users' perceptions of inpatient care, using a participatory methodology. Journal of Mental Health 21, 5771.
Faulkner, A (2005). Institutional conflict: the state of play in adult acute psychiatric wards. Journal of Adult Protection 7, 612.
Gilburt, H, Rose, D, Slade, M (2008). The importance of relationships in mental health care: a qualitative study of service users experiences of psychiatric hospital admission in the UK. BMC Health Services Research 8, 92.
Gilburt, H, Slade, M, Rose, D, Lloyd-Evans, B, Johnson, S, Osborn, D (2010). Service users' experiences of residential alternatives to standard acute wards: qualitative study of similarities and differences. British Journal of Psychiatry 197, S26S31.
Gillard, S, Borschmann, R, Turner, K, Goodrich-Purnell, N, Lovell, K, Chambers, M (2010). ‘What difference does it make?’ Finding evidence of the impact of mental health service user researchers on research into the experiences of detained psychiatric patients. Health Expectations 13, 185194.
Gordon, D, Alexander, DA, Dietzan, J (1979). The psychiatric patient: a voice to be heard. British Journal of Psychiatry 135, 115121.
Harding, S (1991). ‘Strong objectivity’ and socially situated knowledge. In Whose Science? Whose Knowledge? (ed.) Harding, S, pp. 138163. Cornell University Press: New York.
Henkel, H, Stirrat, R (2001). Participation as spiritual duty; empowerment as secular subjection. In Participation, the New Tyranny? (ed.) Cooke, B and Kothari, U, pp. 168184. Zed Books: London.
Higgins, R, Hurst, K, Wistow, G (1999). Nursing acute psychiatric patients: a quantitative and qualitative study. Journal of Advanced Nursing 29, p5263.
Jenkins, R, Elliott, P (2004). Stressors, burnout and social support: nurses in acute mental health settings. Journal of Advanced Nursing 48, 622631.
Kendall, T, Crawford, M, Taylor, C, Whittington, C, Rose, D (2012). Improving the experience of care for adults using NHS mental health services: summary of NICE guidance. British Medical Journal 344, 13631365.
Laker, C, Rose, D, Flach, C, Csipke, E, McCrone, P, Craig, T, Kelland, H, Wykes, T (2012). Views of the Therapeutic Environment (VOTE): Stakeholder involvement in measuring staff perceptions of acute in-patient care. International Journal of Nursing Studies 49, 14031410.
Mason, R, Boutilier, M (1996). The challenge of genuine power sharing in participatory research: the gap between theory and practice. Canadian Journal of Community Mental Health 15, 145152.
MIND (2004). WardWatch. MIND: London.
Peplau, H (1952). Interpersonal relations in nursing. American Journal of Nursing 52, 765.
Pope, C, Mays, N (ed.) (2008). Qualitative Research in Health Care.
Quirk, A, Lelliott, P (2001). What do we know about life on acute psychiatric wards in the UK? A review of the research evidence. Social Science and Medicine 53, 15651574.
Rose, D (2001). Users' Voices. Sainsbury Centre for Mental Health: London.
Rose, D, Evans, J, Sweeney, A, Wykes, T (2011). A model for developing outcome measures from the perspectives of mental health service users. International Review of Psychiatry 23, 4146.
Sainsbury Centre for Mental Health (1996). Acute Problems. Sainsbury Centre for Mental Health: London.
Saxena, S, Barrett, T (2007). Atlas: Nurses in Mental Health 2007. World Health Organisation Press: Geneva.
Sharac, J, McCrone, P, Sabes-Figuera, R, Csipke, E, Wood, A, Wykes, T (2010). Nurse and patient activities and interaction on psychiatric inpatients wards: a literature review. International Journal of Nursing Studies 47, 909917.
Sullivan, P (1993). Occupational stress in psychiatric nursing. Journal of Advanced Nursing 18, 591601.
Walsh, J, Boyle, J (2009). Improving acute psychiatric hospital services according to inpatient experiences. A user-led piece of research as a means to empowerment. Issues in Mental Health Nursing 30, 3138.
Wing, J, Marriott, S, Palmer, C, Thomas, V (1998). The Management of Imminent Violence: Clinical Practice Guidelines to Support Mental Health Services. Royal College of Psychiatrists: London.


Type Description Title
Supplementary materials

Rose et al. Supplementary Material

 Word (35 KB)
35 KB

Life in acute mental health settings: experiences and perceptions of service users and nurses

  • D. Rose (a1), J. Evans (a1), C. Laker (a1) and T. Wykes (a2)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed