Risk management by patients on psychiatric wards in London: An ethnographic study

Abstract

The purpose of this study was to explore everyday life on acute psychiatric admission wards, focusing on the experience of patients. Using a grounded theory approach, data were collected by ethnographic methods on three wards in London, UK. This paper is concerned with the issue of how patients manage risks arising from their interaction with other patients on the ward, such as assault and sexual harassment. Patients were observed doing this in various ways including: (a) avoiding risky situations or individuals; (b) de-escalating potentially risky situations; (c) seeking safety interventions by staff or increased surveillance; and (d) protective involvement with other patients. These findings show that patients routinely take an active role in making a safe environment for themselves, partly because they cannot rely on staff to do this for them. Mental health professionals should consider how to build upon what patients are already doing to maximise ward safety.

Keywords:

• Psychiatric patients
• psychiatric hospital
• risk management
• ethnography
• United Kingdom

Acknowledgements

The authors wish to thank all of the patients, staff and managers at the three hospitals involved, many of whom gave considerable amounts of their time to the study. We would also like to thank the two anonymous reviewers for their very helpful comments on an earlier draft of this paper. We are especially grateful to Jim Birley, whose generous donation to the College Research Unit funded the research.