Consumers Accessing Their Mobile Phone in an Acute Inpatient Mental Health Unit: Experiences of Consumers and Staff

Abstract

Mobile phones are an essential means for remaining connected, yet many acute inpatient mental health units restrict consumer access to their mobile phones due to safety concerns. The ubiquitous nature of mobile phones makes this approach seemingly incongruent with contemporary mental health practice. One Local Health District in Australia evaluated the implementation of a process that provided mental health consumers access to their mobile phones while in hospital. This study used a mixed methods design to explore the views of consumers and nurses, both before and after implementation. Participants were asked about their perceptions of the importance of mobile phone access to people in acute units, and their views about any perceived (pre) and actual (post) issues, challenges or benefits associated with the change in practice. Survey responses showed significant differences across group on all measures, with consumers more likely to rate the importance and frequency of mobile phone use higher, while also significantly more likely to rate potential issues lower. Issues associated with consumer phone access were rated lower in the post surveys. Descriptive content analysis of qualitative data identified differences in the level of concern between staff and consumers about consumers having access to their phone before implementation. Views about the therapeutic benefits and level of concern also changed post implementation. The need to have a clear process for implementation and governance was identified by both groups. The findings support consumers having access to their phone during admissions to acute mental health units.

Introduction

Historically, acute mental health inpatient units have prohibited mobile phones or other electronic devices (e.g. tablets, laptops) for all consumers admitted to hospital (O’Connor et al., 2018). An Australia study found that 85% of units denied mobile phone access to consumers while in hospital due to concerns about impaired judgement, harm to self, others, or reputation (O’Connor et al., 2018). A number of acute adult mental health units do provide consumers with access to their mobile phones during admissions (Francis & Lloyd, 2017; O’Connor et al., 2018). People are increasingly reliant on mobile phones for essential day-to-day functioning (Wilson, 2022), and prohibiting consumer access to mobile phones may adversely impact on consumers’ ability to maintain important relationships and life tasks (Morris, 2018), as well as adversely impacting on personal wellbeing, identity and connection (O’Connor et al., 2018). However, the association between access to phones and consumer’s wellbeing, and their overall experience of care, remains largely unknown. There is a surprising lack of literature on mobile phone use in mental health settings, except as a vessel for delivering therapeutic interventions.

One study examined the attitudes of consumers and staff in relation to the potential benefits and risks involved in giving consumer’s access to phones (O’Connor et al., 2018). They found that the risks associated with access to phones were recognised by both staff and consumers, and both agreed on a need for careful assessment of use. Staff were found to underestimate the importance of access to phones for maintaining social connection and recovery (O’Connor et al., 2018). Another study reported the results of a local policy change that gave consumers access to their mobile phones (Francis & Lloyd, 2017). They established a set of guidelines and a local protocol, which directed the treating team to undertake individual assessments as to peoples’ suitability for access to personal phones. Individual written contract agreements were part of this protocol. The researchers collected brief consumer feedback which elicited positive responses with consumers reporting that they were ‘grateful’ and ‘appreciative’ of having access to their phones (Francis & Lloyd, 2017).

Most of the literature around the use of mobile phones and mental health consumers focuses on the use of e-health technologies and their utility for providing adjunctive mental health therapeutic interventions (Proudfoot, 2013; Wilson, 2022). Some studies have examined the role of electronic devices in providing therapeutic outcomes for those people experiencing mental health issues including within hospital settings, and the application of this technology is well recognised (Wilson, 2022). Consumers identify a number of strategies that can be utilised via mobile phones that can assist with mental health recovery including managing mood, anxiety, and stress, as well as monitoring symptoms and strategies to assist with sleep (Noel et al., 2019). Access to mobile phone apps present opportunities for consumers in hospital to be able to access strategies for managing distress, setting goals and monitoring recovery (Khimy et al., 2014; Wilson, 2022).

Globally mental health services are working towards a recovery-oriented approach that involves reducing restrictive practices including any practice which inhibits choice or personal freedom (Tingleff et al., 2017; Wilson et al., 2018). Recovery-oriented practice describes the need for services to support consumer autonomy and independence. This includes providing opportunities for individuals to pursue strategies and activities that facilitate and promote a satisfying and meaningful life (Slade, 2012). There is an inherent conflict that exists between being recovery-oriented and the practice of restricting access to mobile phones for all consumers (NSW Mental Health Commission, 2014). Restriction of access to mobile phones has implications for people’s connection to their peers (Briere et al., 2012), legal rights and health information (Morris, 2018). The potential benefits of using mobile phones to support mental health wellbeing is well documented (Khimy et al., 2014; Noel et al., 2019), Furthermore, supporting people’s access to tools that can maintain social connectedness is known to be critical for recovery (Noel et al., 2019). Despite this, many units remain risk averse, suggesting a need to understand the perspectives of both staff and consumers in relation to phone use. It is therefore important that the management of risk associated with mobile phone access is reviewed to ensure it is consistent with contemporary approaches (Muir-Cochrane & Duxbury, 2017; Wand et al., 2020).

In one health district in regional New South Wales, Australia, clinical and lived experience staff members raised concerns about the practice of restricting all access to their mobile phones within acute units. This led to a project undertaken in one acute mental health inpatient unit with the support of the Executive, to develop a process to enable consumer’s access to their mobile phones during admission. Therefore, this study aimed to explore the views of consumers and staff about consumers having access to their mobile phone while admitted to an inpatient mental health unit.

Methods

Design

This study utilised both descriptive qualitative and quantitative measures via pre and post questionnaires and focus groups. The study was a health service evaluation conducted within existing resources and as such used a pragmatic design. Pragmatic research commonly explores the ‘real world’ undertaking of initiatives within healthcare, with a focus on feasible methods and fitting into clinical contexts (Holtrop & Glasgow, 2020).

Setting

This study was conducted across one site within a Local Health District located in a regional centre of New South Wales, Australia between August 2019 and December 2022. Pre implementation data were collected from two units, but the process was subsequently only implemented in one unit. The study was approved by the local Human Research Ethics Committee.

Data collection tools

Staff and consumer survey

The survey was based on a scale by O’Connor et al. (2018), adapted with permission for the purposes of this study. The original survey sought the views from staff and consumers regarding the importance of specific mobile phone functions and access to mobile phones within inpatient units (O’Connor et al. 2018). Modifications for this study by the research team reflected the intention to measure these items pre and post implementation of a practice change that permitted the use of mobile phones in hospital. Face validity was established by the research team and the final survey consisted of 36-items rated on Likert scales, arranged in four groups. Question groups explored the importance of phone functions (1 – Not important at all; 5 – Extremely important), the frequency of use for phone functions (1 – Practically never; 5 – Several times a day), perceptions of issues (pre) and their perceptions of the actual issues (post) that may arise as a result of implementing this change of practice (1 – No issue; 7 – Major issue) and statements in relation to consumers having access to their mobile phone while in hospital (1 – Strongly disagree; 5 – Strongly agree). The staff survey was online, whereas consumers were provided with a hard copy version. Hard copy surveys were also available to staff at post.

Consumer and staff focus groups

Semi-structured focus groups were conducted separately with staff and consumers in the unit where the practice change was implemented. Participants were asked questions about their views and experiences regarding consumers access to their mobile phones while in hospital. All focus groups were facilitated by a member of the research team with extensive clinical and focus group experience.

Consent

For staff, completion of the surveys and attendance at focus groups was considered implied consent. For consumers, written informed consent was collected for both surveys and focus groups.

Recruitment

Participants

Staff from all disciplines working in the units were invited to take part via an email from the research team. The email contained the information statement and a link to the online survey where staff participants were able to access and complete the survey at their convenience. The email also included an invitation to attend a focus group. Those that expressed interest in participating in the focus group were approached by a member of the research team who confirmed consent and arrangements to attend the focus groups were made.

All consumers admitted to the units where the study took place were verbally invited to take part in the study. Prior to implementation staff assisted in the recruitment process including advertising the study to potential participants and providing information statements. Those that expressed interest were approached by staff who in turn notified a member of the research team who arranged to facilitate consent, confirm the information statement and arrange a suitable time to conduct the focus groups. Consumers who had access to their mobile phones during the study period were eligible to participate in the post data collection and were recruited using the same process as described within the pre data collection period. Consumer recruitment was also supported by a peer worker where possible.

Data analysis

Focus groups

All focus groups were recorded and manually transcribed by a member of the research team. A process of inductive content analysis was used to analyse the data (Vears & Gillam, 2022). Data were read for familiarity and then initial coding undertaken to identify broad categories of content. Coding was iterative and focused on identifying snippets of data relevant to the study aims and labelling them descriptively (Vears & Gillam, 2022). A second round of coding enabled the refinement of the initial broad categories of content into sub-categories which were subsequently condensed and synthesised into a narrative description of the experiences of each group’s key points. Illustrative quotes were chosen to link the synthesised findings to participants’ descriptions (Lingard, 2019).

Survey

Survey data were analysed using the IBM Statistical Package for Social Sciences (SPSS Volume 29: IBM Corp). Descriptive data were analysed using chi-square to identify differences in the composition of the sample characteristics. Exploratory factor analyses were conducted to guide construction of subscales within the (1) importance and (2) issues of concern sections (note—as frequency of use contained the same items as importance, the subscales identified underlying the importance data were replicated for frequency of use data). Average scores for subscales were used in a 2 × 2 Factor ANOVA (group - staff, consumer; time - pre, post) to explore any differences between groups, time and to explore any differential change in group across time.

Results

Quantitative data

A total of 25 staff and 24 consumers completed the survey pre and 24 staff and seven consumers completed the survey post. Key demographics of survey respondents are shown in Table 1.

Table 1. Descriptive statistics across group (staff, consumer) and time (before, after).

	Staff			Consumer
	Pre (n = 25) n (%)	Post (n = 24) n (%)	Χ^2p	Pre (n = 24) n (%)	Post (n = 7) n (%)	Χ^2p
Age
Less than 35	15 (60.0%)	18 (69.2%)	0.778	14 (60.9%)	1 (14.3%)	0.042
36–55	9 (36.0%)	7 (26.9%)		5 (21.7%)	5 (71.4%)
56 or more	1 (4.0%)	1 (3.8%)		4 (17.4%)	1 (14.3%)
Gender
Male	8 (32.0%)	8 (32.0%)	1.00	11 (50.0%)	5 (83.3%)	0.144
Female	16 (64.0%)	16 (64.0%)		11 (50.0%)	1 (16.7%)
Prefer not to say	1 (4.0%)	1 (4.0%)		–	–
Discipline
Nursing	17 (68.0%)	22 (91.7%)	0.117	–	–	–
Medical	3 (12.0%)	1 (4.2%)		–	–
Allied health	5 (20.0%)	1 (4.2%)		–	–

Tables 2 and 3 shows differences in perspectives between staff and consumers across a range of characteristics regarding consumer phone access, while also showing how some of these perspectives changed overtime. Compared with staff, consumers ratings were significantly higher on the overall importance (F _{(1, 77)} = 5.03, p = 0.012) of mobile phone access while in hospital, and consumers were also significantly more likely to rate the expected frequency of use higher than staff (F _{(1, 75)} = 7.48, p = 0.003). When exploring specific phone functions, differences in staff and consumer perspectives was largest regarding the use of mobile phones for entertainment and basic communication, with consumers significantly more likely to rate both the importance (F _{(1, 77)} = 9.27, p = 0.003) and frequency of use (F _{(1, 76)} = 20.91, p < 0.001) higher than staff. There was, however, a significant group by time interaction for both the overall rating on frequency of use (F _{(1, 75)} = 4.64, p = 0.034) and the frequency of using phones for entertainment and basic communication (F _{(1, 76)} = 5.23, p = 0.025), which largely reflected an increase in the staff rating post implementation. There was no difference in staff and consumer ratings on functions relating to social engagement and general internet, which were rated low on importance and frequency of use by both groups, and across both timepoints.

Table 2. Group (staff, consumer) and time (before, after) differences in perspectives: Importance and frequency of consumer mobile phone use while in hospital (2 × 2 ANOVA).

	Staff		Consumer
	Pre (n = 25) Mean (SD)	Post (n = 24) Mean (SD)	Pre (n = 24) Mean (SD)	Post (n = 7) Mean (SD)	Timep	Groupp	Time × Groupp
Importance
Entertainment and basic communication	2.43 (1.18)	2.61 (0.77)	2.92 (0.66)	3.49 (0.36)	0.103	0.003	0.397
Calls/SMS	2.54 (1.47)	2.88 (1.15)	3.25 (0.74)	3.86 (0.38)
Music	2.88 (1.20)	3.19 (0.90)	3.50 (0.78)	4.00 (0.00)
Emails	2.04 (1.24)	2.12 (0.99)	2.17 (1.23)	3.43 (0.79)
Games	2.12 (1.33)	2.00 (1.16)	2.70 (1.30)	2.29 (1.25)
Banking/Bills	2.54 (1.35)	2.88 (0.93)	2.95 (1.00)	3.86 (0.38)
Social engagement and general internet	1.22 (1.33)	1.18 (0.88)	1.46 (1.07)	1.79 (1.15)	0.620	0.142	0.531
Social media	1.44 (1.45)	1.65 (1.41)	1.65 (1.43)	1.57 (1.40)
Photos/Video	0.92 (1.35)	0.50 (0.86)	1.13 (1.22)	0.57 (0.98)
Internet	1.60 (1.53)	1.80 (1.26)	1.91 (1.31)	2.86 (0.90)
Internet shopping	0.92 (1.29)	0.85 (0.93)	1.22 (1.20)	2.14 (1.86)
Overall importance	1.88 (1.13)	1.97 (0.74)	2.28 (0.73)	2.73 (0.67)	0.236	0.012	0.413
Frequency of use
Entertainment and basic communication	1.07 (0.87)	1.98 (1.01)	2.75 (0.8)	2.54 (1.37)	0.153	<0.001	0.025
Calls/SMS	0.32 (0.80)	1.88 (1.84)	3.05 (1.07)	3.14 (1.46)
Music	0.80 (1.29)	2.04 (1.71)	3.30 (0.82)	3.29 (1.50)
Emails	1.54 (1.06)	1.92 (0.95)	2.29 (1.42)	2.14 (2.04)
Games	1.00 (1.32)	1.92 (1.32)	2.57 (1.66)	1.71 (1.70)
Banking/Bills	1.76 (1.05)	2.12 (0.73)	2.50 (1.26)	2.43 (1.40)
Social engagement and general internet	1.17 (0.97)	2.04 (0.72)	2.37 (0.87)	2.25 (1.07)	0.167	0.511	0.179
Social media	0.72 (1.28)	1.76 (1.48)	2.32 (1.67)	1.57 (1.62)
Photos/Video	1.56 (1.47)	2.12 (1.61)	1.48 (1.47)	1.57 (1.99)
Internet	1.04 (1.34)	2.23 (1.53)	2.81 (1.29)	2.43 (1.51)
Internet shopping	1.88 (1.59)	2.27 (1.43)	0.85 (0.93)	2.00 (1.53)
Overall frequency	1.17 (0.97)	2.04 (0.72)	2.37 (0.87)	2.25 (1.07)	0.108	0.003	0.034

Note. Bold indicates global construct score (a collation of all survey items within each construct). Response options and scales scores: importance (0 – not important at all; 4 – extremely important); frequency of use (0 – practically never; 4 – several times a day).

Table 3. Group (staff, consumer) and time (before, after) differences in perspectives: Issues of concern, and agreement with themes regarding consumer mobile phone access while in hospital (2 × 2 ANOVA).

	Staff		Consumer
	Pre (n = 25) Mean (SD)	Post (n = 24) Mean (SD)	Pre (n = 24) Mean (SD)	Post (n = 7) Mean (SD)	Timep	Groupp	Time × Groupp
Issues of concern
Consumers may take a photo or other recording of me or other consumers	6.72 (0.74)	4.08 (2.38)	5.23 (1.97)	2.29 (2.36)
Consumers may access inappropriate material (e.g. pornography, violent content)	5.96 (1.65)	3.37 (2.39)	4.61 (2.59)	1.00 (0.00)
Consumers may purchase inappropriate items online (e.g. drugs or weapons)	6.16 (1.52)	3.29 (2.14)	4.57 (2.29)	1.14 (0.38)
Consumers may overspend online and purchase expensive items they can’t afford	6.32 (1.18)	4.39 (2.23)	5.09 (2.18)	1.00 (0.00)
Consumers may engage in gambling activities online	6.24 (1.17)	4.00 (2.02)	5.48 (1.95)	1.14 (0.38)
Consumers may engage in inappropriate phone calls or messaging via text	6.60 (0.71)	5.50 (1.72)	4.87 (2.14)	1.29 (0.76)
Consumers may post inappropriate images online	6.64 (0.81)	4.08 (2.38)	5.48 (2.15)	1.14 (0.38)
Consumers may give their phone to another consumer who is vulnerable	6.52 (0.87)	5.62 (1.64)	5.05 (2.38)	1.57 (0.79)
Consumers may be distracted by their phone and not engage in their treatment	5.32 (2.10)	4.87 (1.90)	4.64 (2.26)	1.29 (0.49)
Consumers may lose or break their phone and hold health service or staff responsible	5.52 (1.94)	3.08 (2.13)	4.41 (2.22)	1.00 (0.00)
Overall issues	6.20 (0.92)	4.23 (1.66)	4.94 (1.72)	1.31 (0.53)	<0.001	<0.001	0.026
Agreement with statements
Restriction: stigma/discrimination	1.26 (1.18)	1.87 (1.23)	2.35 (1.15)	3.00 (1.27)
Restriction: difficult to justify	1.70 (1.33)	2.04 (1.23)	2.48 (0.90)	2.86 (0.90)
Restriction: negative impact	1.48 (1.31)	2.12 (1.12)	2.52 (1.04)	3.17 (1.33)
Consumers should have access?	2.13 (1.42)	2.58 (1.06)	2.71 (1.10)	3.43 (0.79)
Therapeutic benefits of access	2.17 (1.34)	2.67 (1.01)	3.00 (0.85)	3.57 (0.79)
Importance of connecting outside hospital	2.09 (1.31)	2.71 (1.08)	2.78 (1.17)	3.71 (0.76)
Overall agreement	1.80 (1.14)	2.33 (0.98)	2.66 (0.79)	3.25 (0.87)	0.037	0.001	0.901

Note. Bold indicates global construct score (a collation of all survey items within each construct). Response options and scales scores: issues of concern (1 – no issue; 7 – major issue); agreement with statements (0 – strongly disagree; 4 – strongly agree).

When asked to rate how much of an issue a variety of potential situations may pose if/after consumers were provided access to their phones, staff rated significantly higher (i.e. more likely to identify as a major issue) than consumers (i.e. more likely to identify as no issue) (F _{(1, 75)} = 32.54, p < 0.001). There was, however, a significant time (F (_{1, 75}) = 58.49, p < 0.001), and group by time interaction (F _{(1, 75)} = 5.15, p = 0.026), with both consumers and staff significantly more likely to rate issues of concern lower at post when compared to pre, with the greatest change over time observed in the consumer group.

When asked to rate their level of agreement with six different statements regarding consumer access to mobile phones, across all measures, consumers were more likely to rate higher than staff on. Consistent with this observation, the ANOVA on the overall agreement with these statements showed that while agreement was significantly more likely in consumers (F _{(1, 72)} = 11.16, p = 0.001). There was however, a significant effect of time (F _{(1, 73)} = 4.52, p = 0.037), with both groups more likely to have a higher overall agreement at post implementation (Table 3) suggestive of an overall attitudinal change within both groups.

Qualitative data

Pre-implementation

Prior to implementation of the change in access to mobile phones, two semi-structured staff (n = 12) and two semi-structured consumer (n = 8) focus groups were conducted. Focus groups ran for between 13 and 41 min. All staff who participated in the focus groups were nurses.

Nurse participants’ views

Within the pre-focus groups, Nurses expressed strong views that the current practice of restricting all consumers’ access to their mobile phone was a valid approach due to the significant risks associated with allowing consumers access to their phones. Risks identified included risk to reputation, financial vulnerability and sexual safety concerns. Nurses identified that restricting phone use was part of their duty of care.

Concerns were also raised about potential increases in nursing workload if consumers had access to their phones, due to an additional need to monitor and assess how phones were being used and the need to monitor the overall environment and keep all consumers safe. Nurses raised concerns that allowing consumers access to their phones might impact adversely on nurse-consumer relationships through conflict about phone usage. Fears about conflict related to staff having to put limits on excessive or inappropriate phone use, staff having to monitor phone use or staff having to mediate interactions between consumers that involved phones. For example, one nurse described:

I think it’s really unwise, as much as people enjoy their phones that would calm a lot of situations down, the risks are enormous…I can imagine the conflict that’ll happen over mobile phones.

Potential benefits of phone usage such as contacting family and friends and using phones for self-soothing were acknowledged but were superseded by concerns that consumers may film nurses or other consumers and violate privacy.

Consumer participant views

Consumer participants emphasised the potential benefits of having access to their phones, such as communicating with others, attending to everyday tasks like banking, maintaining personal contact through email, and listening to music. For example,

Sometimes it’s like you do need it for like work and stuff…and I had to wait so long…just to get my phone back so…like people have like work or situations at home or something, or maybe it’s a parent that wants to contact their kids and they don’t want, maybe they just want to message their kids or something like that…

Consumers reported that without their own phones they had to use the communal phone, which lacked privacy. There were some concerns about being recorded or filmed by other consumers if mobile phones were available, with some acknowledging that they enjoyed a break from their phone. The majority of participants felt that they could better use their time while in hospital if they had their phone to ‘get things done’ and to stay engaged with work and home.

Post implementation

In the post implementation phase three focus groups were conducted with nursing staff. Twelve nurses attended across three focus groups, which lasted between 36 and 40 min. Two consumers attended the only post-consumer focus group, which lasted for 35 min.

Nurse participants’ views

Nurse participants described a number of benefits from consumers having their phones including incorporating the phone into care-planning and safety-planning and for facilitating discharge arrangements. Nurses described consumers using their phones for listening to music, making phone calls, using social media, banking and watching shows. In general, phones were described as useful for self-soothing and distraction in response to the stress of being in hospital. Nurses reported minimal incidents regarding phones in the 12 months since the change of practice had been implemented. There were a few instances where consumers had been posting material deemed inappropriate on social media, resulting in the removal of phones, however, minimal conflict was reported. Nurses also found that they were providing support to consumers experiencing distress about not having their phones or in situations where phones had been removed. At times this could adversely impact on nurse-consumer engagement and lead to increased workload of monitoring phone use. However, nurses perceived that overall benefits outweighed risks and that the change in practice to provide consumers access to their phones was beneficial. As described by a nurse:

I’ve found the positives outweigh the negatives…if the risk assessment is good…the large majority do get benefit from their phone…it doesn’t cause them more distress, they use it appropriately…it gives them like consumer autonomy basically it gives them the dignity of risk to be able to use their phone, be able to connect with the outside world, attend their banking address their psychosocial stressors, seek housing, jobs, like it’s a really good pathway for them, it’s good for their own distraction, it’s good for learning different techniques…it improves their ability to make their own health choices…

Nurse’s identified that they should be more involved in the decision-making process around phone access and at times felt excluded from this process. A need for more communication within the team about ongoing mobile phone use among consumers was identified.

…generally beneficial I think, generally I think it’s beneficial, I think for some people restrictions are appropriate…I think getting that sweet spot of…what is the least restrictive…so I think it has been beneficial…

Participant 1 Focus Group 2

Consumer participants

Both participants were positive overall about the opportunity to access their mobile phones while in hospital. They considered the process of individual assessment to be a ‘good’ system. While acknowledging that having access to their phones needed to be carefully managed there were a number of advantages identified. These included improved privacy and confidentiality, a useful distraction tool to cope with unwanted events in the unit and a means of accessing outside information through apps and communication platforms as illustrated in the following quote:

I think it shields me from a lot of stuff… it’s sort of a barrier…distract myself…research anything I like, read if I can, listen to music…I’ve not long got a new phone and it’s just been my life since I got it really, music anything you can do…I’ve basically been using it for music mainly to drown out stuff I don’t like hearing around me… it’s helped a lot…

Participants identified areas for improvement around the process of gaining access to their phones, in particular a need for clear communication between staff and consumers about the user agreement and timelier follow up from staff in situations where phones were not being used respectfully by consumers. While there were some initial concerns about other consumers recoding or taking photos of them without consent, this had not occurred in their experience and was summed up by the following quote:

I thought it would be…I really did, when I came in and I saw that device for charging and I learned that people were using their phones I thought there was going to be a whole heap of that photos and crap going on, I really did…I generally I think, if ten is bloody awesome having your phone and one is a bit shit, it’s a solid 7.5 or an 8. It’s a good thing overall

Discussion

This study described the views of nurses and consumers of implementing a process to allow consumers’ access to their mobile phone while in hospital. The pragmatic design enabled exploration of the experiences of nurses and consumers across the implementation period of a practice change initiative. The results showed a largely successful implementation and transition to providing phones for consumers while in hospital. After initial concerns raised by nurses, the process of allowing consumers access to their mobile phones was viewed as beneficial. Specifically, the therapeutic benefits around distraction, self-soothing, listening to music and connecting with family and friends were identified.

There is an imperative for mental health services to be recovery-oriented by exploring ways of providing choice, autonomy and personal connectedness (Solomon et al., 2021). Allowing consumers their phones is one example of a practical step towards realising this imperative. In the current study, differences between staff and consumer perspectives were apparent. Nurses were initially concerned about risks, and identified that removing phones was a mechanism of safety. While consumers focused more on the potential therapeutic benefits of phone use and the importance of maintaining possession and access of these devices. Survey findings also support this difference with staff predicting a higher likelihood of adverse issues associated with the change than consumers. This discrepancy between staff and consumer views about mobile phone use has been reported previously by O’Connor et al. (2018) who found that staff underestimated the importance of mobile phones for maintaining personal connection and recovery for consumers.

This is the first published study to examine staff and consumer views before and after implementation of a process to provide consumers with access to their mobile phones while in hospital. There was a significant shift in perspective before and after implementation, with both staff and consumers significantly more likely to agree with statements about the therapeutic benefits of consumers accessing their mobile phones and significantly less likely to identify any issues of concern. This is consistent with the qualitative findings that illustrates the therapeutic opportunities of consumers accessing their mobile phone while in hospital. These findings provide evidence on the importance of ensuring that policy is framed to meet the needs of consumers in contemporary mental health service provision.

Reducing restrictive practices within in acute inpatient mental health units is a complex and challenging process (Duxbury et al., 2019; Bowers, 2014). Nurses in this study initially expressed a strong sense of responsibility to manage risks and protect consumers from harm by whatever means necessary, including a blanket approach to restricting access to mobile phones. This suggests a risk averse approach to ‘controlling’ risks rather than facilitating positive risk taking (Slade, 2012). O’Connor et al. (2018) also found that staff tended to focus on the risks associated with consumers using mobile phones. These findings also highlight ongoing tensions with principles of recovery orientation in acute services and is indicative of the power differential between staff and consumers (Scholz et al., 2018). Sharing of power is needed for effective positive risk taking and recovery oriented practice to be established (Birch et al., 2011; Solomon et al., 2021).

Contemporary approaches to managing risk in mental health call for a shift in emphasis from being risk averse to a safety planning approach which outlines strategies to minimise and respond in ways that promote personal safety (Wand et al., 2020; Higgins et al., 2016). There is an opportunity to align this shift in emphasis with the way that consumers access and use their phones while in hospital and employ a safety-planning approach. The findings of this study suggest that while initially a risk averse approach was being taken, concerns expressed did not translate to non-minor incidents occurring within the study period.

The study highlighted the importance of involving the consumers in discussions about access to their mobile phone. This is closely related to the need for clear multidisciplinary communication and collaboration to ensure that all information is considered in decisions about phone access. Nurses identified that they are well placed to facilitate consumer involvement in decisions about phone access as they spent the most time with them. In addition, consumers could identify for themselves that at times a break from their phone was beneficial which could be incorporated into the collaborative care planning process. Consumers in this study valued the therapeutic benefits of having access to their mobile phone while in hospital. They also wanted to be involved in and informed about decisions around having access to their mobile phone. While consumers recognised potential risks associated with phone access, their experience on this unit highlighted a workable model and confidence in working effectively with nurses to safely address any concerns without compromising the therapeutic relationship.

Conclusion

This study employed a mixed methods approach to investigate the views of consumers and staff around the implementation and evaluation of mental health consumers having access to their mobile phone while in hospital. Results of this study provide valuable insights into the therapeutic benefits of phone access for consumers, as well as demonstrating how associated risks can be addressed through this process. This also serves as an example of contemporary practice that seeks to promote consumer autonomy and minimise restrictive practice.

Relevance for clinical practice

This study highlights one example of service delivery that can align with recovery-oriented practice. While there may be ongoing requirements to identify and respond to risks associated with mobile phone use, this study highlighted the possibilities of engaging a positive risk taking approach to phone use rather than one that is risk averse.

Limitations

The sample size from the survey was small and there is limited statistical power that can be derived from the results. There were only two consumers in the post implementation focus group which may limit the depth of perspectives shared. Due to COVID-19 there was an 18 month period in between pre and post data collection instead of the planned 3 months. This meant that staff turnover impacted continuity of staff on the unit. Staff in the post focus groups had not necessarily been present pre or during implementation. However, the extended implementation period could be seen as a benefit as a longer period still didn’t result in non-minor issues associated with consumer phone use being realised.

Author contributions

All listed authors meet authorship criteria according to the guidelines of the Internationals Committee of Medical Journal Editors. All authors are in agreement with the manuscript.

Acknowledgements

The authors would like to thank all the consumers and staff that participated in this study, the members of the working party, those who developed the guideline on which this study was based, and everyone who contributed to the implementation of this project. There was no funding associated with this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.