title: The importance of relationships in mental health care: a qualitative study of service users' experiences of psychiatric hospital admission in the UK.
abstract: BACKGROUND
  While a number of studies have looked at life on service users' experiences of life on psychiatric wards, no research exists that have approached these experiences from the user perspective since the introduction of community care.
  
  
  METHODS
  This user-led study uses a participatory approach to develop an understanding of the processes and themes which define the user experience of hospitalisation. Nineteen service users who had all had inpatient stays in psychiatric hospitals in London were interviewed in the community.
  
  
  RESULTS
  Relationships formed the core of service users' experiences. Three further codes, treatment, freedom and environment defined the role of hospital and its physical aspects. Themes of communication, safety, trust, coercion, and cultural competency contributed to the concept of relationships.
  
  
  CONCLUSIONS
  Relationships with an individual which comprised effective communication, cultural sensitivity, and the absence of coercion resulted in that person being attributed with a sense of trust. This resulted in the patient experiencing the hospital as a place of safety in terms of risk from other patients and staff. Barriers to positive relationships included ineffective and negative communication, a lack of trust, a lack of safety in terms of staff as ineffective in preventing violence, and as perpetrators themselves, and the use of coercion by staff. This unique perspective both acts as a source of triangulation with previous studies and highlights the importance of the therapeutic relationship in providing a safe and therapeutic milieu for the treatment of people with acute mental health problems.
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Kings College London, London, SE5 8AF, UK. helen.gilburt@iop.kcl.ac.uk
authors.forename: Helen
authors.initials: H
authors.lastname: Gilburt
authors.forename: Diana
authors.initials: D
authors.lastname: Rose
authors.forename: Mike
authors.initials: M
authors.lastname: Slade
mesh_terms: D003068:Coercion; D054521:Cultural Competency; D005260:Female; D015285:Hospital-Patient Relations; D006760:Hospitalization; D006778:Hospitals, Psychiatric / Q000592:standards; D006801:Humans; D007297:Inpatients / Q000523:psychology; D007407:Interviews as Topic; D008297:Male; D036301:Qualitative Research; D012449:Safety; D035502:Trust / Q000523:psychology; D006113:United Kingdom