Women and mental health hospitalisation: An exploration of their experiences and outcomes

Abstract

The overall aim of this thesis was to investigate women's experiences of, and outcomes from, a mental health related hospitalisation. The thesis is comprised of three papers. The first is a systematic review and meta-analysis, the second a qualitative study and the third, a critical reflection of the work conducted. The systematic review and meta-analysis (paper 1) had several aims. The first aim was to determine how many research studies disaggregated data by sex in relation to global functioning outcomes from a mental health hospitalisation. Where such data was provided, the second aim was to explore whether females had poorer outcomes compared to males. Further, it was aimed to determine the strength and magnitude of any effect found and the quality of the available evidence. Thirty-six papers were included in the review. A very small but significant effect was found (g = 0.110, CI 0.010 - 0.210, p = 0.032), suggesting that women had superior global functioning outcomes compared to men. However, the effect was found only in a sub-group analysis or when an outlying study was removed. The quality of the evidence was also found to be weak or moderate in most cases. Based on the quality of studies available, it is not clear whether differences observed represent a true sex difference or whether the difference could be related to other confounding factors. Further, only around 8% of otherwise eligible studies were included in the review, indicating that examining sex differences is not currently a priority in mental health research. The empirical paper (paper 2) explored women's experiences of day-to-day restrictive practices as inpatients using qualitative research methodology. Semi-structured interviews were conducted with 22 women who were all currently inpatients in a range of mental health settings. Thematic analysis was used, and one overarching theme was developed of powerlessness in relation to restrictive practices. Five key subthemes were also identified: restrictions perceived as punitive, having no voice, compliance, relationships, and safety. Restrictive practices were found to impact upon the women's well-being, leading to increases in self-harm and feelings of worthlessness. Although restrictions could provide women with a sense of safety, as their mental health improved, their feelings of powerlessness in relation to restrictions increased. These results indicated that day-to-day restrictive practices, although less obviously traumatic than restrictive interventions such as seclusion and restraint, can also have a damaging effect. The importance of gender-informed care for women that fosters empowerment, independence and allows women to have their voices heard is highlighted. Finally, a critical appraisal (paper 3) of the research is provided. The strengths of the research are considered as well as alternative approaches that could have been used. The contribution of the research to the field and the implications for clinical practice are discussed. The researcher also offers some personal reflections on the process of completing this thesis.

Date of Award	31 Dec 2020
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Katherine Berry (Supervisor), Dawn Edge (Supervisor) & Sandra Bucci (Supervisor)