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ORIGINAL RESEARCH article

Front. Psychiatry
Sec. Psychological Therapy and Psychosomatics
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1501945

Barriers to the implementation of psychosocial interventions on acute mental health wards: An ethnographic observational study

Provisionally accepted
Katherine Berry Katherine Berry 1*Isobel Johnston Isobel Johnston 2Paul Wilson Paul Wilson 2Gillian Haddock Gillian Haddock 2Sandra Bucci Sandra Bucci 2Karina Lovell Karina Lovell 2Owen Price Owen Price 2Adele Beinaraviciute Adele Beinaraviciute 3Gillian Gilworth Gillian Gilworth 3Sonalia Kaur Sonalia Kaur 2Helen Morley Helen Morley 2Georgina Penn Georgina Penn 3Jessica Raphael Jessica Raphael 2Mica Samji Mica Samji 3Richard James Drake Richard James Drake 2Dawn Edge Dawn Edge 2
  • 1 Manchester University, North Manchester, United States
  • 2 Victoria University of Manchester, Manchester, England, United Kingdom
  • 3 Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom

The final, formatted version of the article will be published soon.

    Background It is notoriously challenging to deliver psychosocial interventions on acute mental health wards. This paper presents an ethnographic observational study which captured how ward and staff processes impacted on the delivery of a psychosocial intervention called TULIPS (Talk, Understand and Listen for Inpatient Settings). Although the paper is focused on one specific intervention, the findings have implications for the delivery of other psychosocial interventions within acute mental health settings. Method We carried out participant observation across 6 case studies wards all participating in the intervention arm of a cluster randomised controlled trial evaluating the TULIPS intervention compared to treatment as usual. Trained researchers observed ward environments, activities and social interactions taking detailed field notes which were later subject to thematic analysis. Results Four themes were generated from field notes relating to aspects of the ward culture and staff behaviours which were barriers or facilitators to the delivery of the TULIPS intervention. Theme one highlighted how the person-centred nature of the TULIPS model was at odds with the pre-existing culture of the wards which favoured blanket rules. Theme two highlighted how staff prioritised task-oriented quantifiable activities which clashed with the emphasis the TULIPS model placed on relationship building. The third theme highlighted the presence of conflict between different groups of staff working on the ward and theme four highlighted the stressful nature of the ward environment which drove staff to seek refuge from patient facing activities including TULIPS related activities. Conclusions In order to successfully engage with the delivery of psychosocial interventions on acute mental health wards, staff need access to supportive leadership which champions psychological interventions, as well as training, supervision and support systems which value the demanding nature of working on mental health inpatient wards.

    Keywords: Ethnographic, inpatient, Mental Health, Observations, Psychosocial Interventions

    Received: 25 Sep 2024; Accepted: 10 Jan 2025.

    Copyright: © 2025 Berry, Johnston, Wilson, Haddock, Bucci, Lovell, Price, Beinaraviciute, Gilworth, Kaur, Morley, Penn, Raphael, Samji, Drake and Edge. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Katherine Berry, Manchester University, North Manchester, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.