Experiences of inpatient settings: eating disorders and deliberate serious self-harm

This thesis explores the views and experiences of inpatient treatment interventions of people with eating disorders, and healthcare support workers’ experiences of witnessing and responding to serious deliberate self-harm. Chapter 1 is a systematic literature review. It critically evaluates qualitative research exploring adults’ experiences of receiving specific, named treatment interventions, delivered across multidisciplinary professions, for eating disorders in inpatient treatment services. Following database searches, 11 studies were identified for inclusion in the review. Eating disorder inpatients described inpatient interventions as facilitating a journey towards self-connection, comprising regaining a healthy autonomy, awareness and acceptance of their cognitions and bodies, and connection with other people. Thus, these services might facilitate the individual inpatients’ journey to self-connection. This could be achieved through consideration of each individual inpatient’s experience from admission to recovery in relation to their individual needs, motivation and readiness to change. Chapter 2 is a qualitative research study. Using interpretative phenomenological analysis, the lived experiences of healthcare support workers, witnessing and responding to their first few incidences of deliberate serious self-harm, are explored. The healthcare workers have had up to their first four months working on inpatient psychiatric service wards. Findings revealed two superordinate themes: ‘connection to the horror’ and ‘power’. ‘Connection to the horror’ describes how healthcare support workers journey to connect to the reality of their role through hearing colleagues’ accounts about previous deliberate serious self-harm incidences, and directly witnessing and responding to their first few incidences of deliberate serious self-harm. ‘Power’ describes dichotomous perceptions of who were perceived by healthcare support workers to hold power on the wards, and how this informed dichotomous responses during deliberate serious self-harm incidences, as well as the power of responding to deliberate serious self-harm as a staff team. Findings could inform how healthcare services support staff cope with their new roles, reducing burnout, sickness absence and high attrition rates, while promoting staff wellbeing and compassionate care. In Chapter 3, the acceptance and commitment therapy approach is used to formulate personal reflections, in the form of thoughts, memories, emotions and physiological sensations, arising during the research. These reflections are reflexively evaluated and emerging themes around containment are discussed