A qualitative exploration of acute mental health inpatient staff’s experiences of working with high-risk behaviours, and the support they receive

Aims: To explore NHS acute mental health inpatient staff’s experiences of working with high-risk behaviours, and what support they receive following exposure to these incidents. Background: Staff working in acute mental health inpatient environments are frequently exposed to high-risk behaviours. Emerging research indicates this can leave staff with symptoms of anxiety, post-traumatic stress disorder and burn-out. Considering the high rates of staff turnover in these environments, the findings are important in understanding how the strain of day-to-day ward experiences can affect staff. However, little is known about the personal impact of working with high-risk behaviours, or what support is available following these incidents. Methodology: This study utilised a qualitative methodology with a constructionist lens. 10 participants were recruited from two NHS mental health Trusts in England. Data was gathered using semi-structured interviews, and analysed using inductive thematic analysis methods. Results: Three main themes emerged: the direct impact of incidents, attempts to manage the impact of incidents and current systems for managing incidents. Staff exposed to violence and aggression felt on edge and unsafe at work. Attempts to mitigate the personal impact of this included ‘just getting on with it’, and remembering that the patients are unwell. Exposure to self-harm and suicide ideation left staff feeling emotionally overwhelmed, deskilled and demotivated. They described higher levels of their own emotional distress as a response to these incidents. Overall, staff felt that support was lacking, and there was a fear that seeking support was a sign of weakness. Conclusion: Clear differences in staff reactions and responses to varying high-risk behaviours were revealed. Support for staff was lacking, which led to unhelpful narratives that spanned ward and management levels. These findings are discussed in relation to existing literature and psychological theories. The clinical implications of this study and directions for future research are explored.