The Relational Institution: An Ethnographic Study of an Inpatient Psychiatric Rehabilitation Ward

Aims Inpatient psychiatric rehabilitation services for people with complex psychosis promote independent living and reduce readmissions through multidisciplinary recovery-based practice. Yet, little research has explored how these are experienced by patients staff, partly due to the difficulties of conducting qualitative in such settings using interviews focus groups. We therefore lack an in-depth understanding inpatient operates on ground, including which aspects as helpful/unhelpful factors determine feasibility/success Methods conducted ethnographic study a 16-bed ward London comprising six months participant observation followed 20 semi-structured (n = 7) staff 13). For observation, over 200 pages fieldnotes were taken contemporaneously. Semi-structured audio-recorded transcribed verbatim. Data analysed grounded theory situational analysis. Results Our analysis highlights fundamental importance relationality rehabilitation. Specifically, is characterised relational impairments divergences that lead significant disability. Working this patient group requires nuanced specialist skills. On ward, skills actively nurtured especially those at lower pay grades, provide essential scaffolding often prevented from prioritising therapeutic relations prevailing structural institutional arrangements. example, greater was attached completing technical bureaucratic interventions; contact reduced more staff; staffing levels material resources activities limited. Already feeling underequipped, members described their motivation cultivate further experiences inequalities inside outside and, proximally, limited psychological occupational support structures. The consequent undermining practice led experiencing treatment restrictive less than it could have been. Conclusion Relationality key determinant experience within units, yet subversion identified reflects currents psychiatry mental health systems nationwide beyond. Recovery-based cultivation rich relationships among strongest evidence bases any interventions psychosis. Therefore, fulfil its clinical potential, investment expertise, well-being, availability frontline who make or break relations. This must be facilitated broader commitments.