Exploring the staff and service user perspectives on the impact of the physical and social environment on service users’ engagement in therapeutic activities in an adult acute mental health inpatient unit

Inpatient care for people experiencing mental health crisis continues to be necessary in the United Kingdom, despite the universal availability of home treatment teams. However, these inpatient care settings have been criticised for providing limited opportunities for service users to engage in therapeutic activities. The care environment is known to impact on service users’ treatment and health outcomes. While most occupational therapy theories and models attest to the importance of the environment in people’s occupational performance and engagement, few reported studies have specifically focused on the mental health inpatient unit’s physical and social environment. Aim This study aimed to explore the views of staff and service users concerning an acute inpatient unit in inner London, to identify factors that impact service users’ engagement in therapeutic activities. Methods Participatory Action Research (PAR) was the overarching methodology used in the two Modules of this study, with multiple methods of data collection, including: quantitative questionnaires, group discussions, mapping activities and qualitative interviews. Findings A total of seventy-three participants, comprising both staff (n=40) and service users (n=33), completed the questionnaires. Four interviews and five PAR group discussions were held with ten staff participants in total. Three key factors impacting service user engagement in therapeutic activities were found to be: (i) building design not fit for purpose; (ii) formal systems and policies compromising user access to spaces; (iii) profession-specific roles and responsibilities. From the findings, it was evident that the physical environment posed the greatest limitation to service user engagement in therapeutic activities and interprofessional collaborative working. Conclusion This study’s findings add clear evidence to the understanding that the physical environment, in particular, but also the social environment within acute mental health units, requires an evidence-based approach to design, alongside robust staff and service user consultation to help facilitate service user’s engagement in therapeutic activities.