A qualitative study exploring adolescents’ experiences of peer relationships in an inpatient CAMHS setting

Aims: To explore the lived experiences of peer relationships within an adolescent psychiatric inpatient setting and investigate how adolescents perceive peer relationships to influence their psychological wellbeing. Background: During adolescence peer relationships play an integral role in development, where shifts occur in attachment from parents towards friendships. Complex and relational trauma are highly prevalent in the inpatient population, this influences the formation of relationships with peers which are intensified within the therapeutic milieu. It is well-known that peer relationships in adolescence can impact on mental health. Such relationships are likely to have a profound influence upon recovery, wellbeing and service outcomes. However, little is known about how these peer relationships are experienced by young people and their influence on psychological wellbeing within the inpatient setting. Methodology: A qualitative methodology was utilized within an interpretivist paradigm. The sample comprised 8 participants; 5 females and 3 males, recruited from a single psychiatric inpatient unit using purposive sampling. Data was gathered from semi-structured interviews and analysed using inductive thematic analysis. Results: Four main themes, each with a number of subthemes, emerged from the dataset. Peer relationships were fragile and jealousy and distrust were common, fuelled by fears of abandonment and rejection. Dilemmas and difficulties within peer relationships were acknowledged, with participants describing competition for staff attention, bullying and challenges with discharge and maintaining boundaries. For some the inpatient environment was experienced as unsafe and triggering, which influenced patients’ recovery and the formation of peer relationships. Relationships brought a number of benefits including normality, shared experience, acceptance and the sense of being cared for. Conclusion: Peer relationships are complex and may have positive and negative influences on psychological wellbeing. Findings are discussed in the context of psychological theory and existing literature. Clinical implications are outlined including staff management of relationships and utilization of peer support.