Increasing access to psychological therapy on acute mental health wards: Staff and patient experiences of a stepped psychological intervention

Background: Psychological therapies are recommended for people with serious mental health problems. However, access is limited, particularly in inpatient mental health settings. The Talk, Understand and Listen in InPatient Settings (TULIPS) study is a large multi-centre cluster-randomised controlled trial which aimed to evaluate a stepped psychological intervention model to increase access to therapies for inpatients. This paper presents findings from the embedded process evaluation focusing on the contextual factors influencing intervention delivery.
Methods: Thirty-two staff and 31 patients from wards receiving the intervention participated in semi-structured interviews. Data was analysed using reflexive thematic analysis. Staff and patient data were analysed separately but perspectives were compared and interwoven resulting in five themes.
Results: Patients reported sessions with psychologists facilitated greater self-understanding and coping. Staff and patients reflected that formulations improved staff understanding of patient presentations. This understanding was associated with improved staff-patient relationships, more person focused practice and reduced conflict and burnout. Psychologists’ frequent physical presence on the wards and support of nursing teams enabled staff buy-in. However, significant barriers in resource, skill and confidence inhibited the delivery of nurse-led interventions within the stepped care model, as did perceptions that intervention delivery was outside the remit of nursing staff’s role.
Conclusions: This study provides evidence that a stepped psychological intervention on acute mental health wards could improve patient coping and ward experience for patients and staff. Future studies should target nursing staff confidence and skill in the delivery of psychological interventions.