Table 2.

Summary of themes and recommendations

Theme (perceptions and experiences related to themes)	Participant group	Implications	Recommendations
Models of care
Acute wards function to stabilise mental states and contain immediate risk	Staff Patient	Patients are discharged as quickly as possible Lack of consideration given to other needs resulting in high rate of readmissions Psychological therapy not started or prioritised No dedicated therapy space	Senior staff need to promote psychosocial models/psychological approaches in terms of understanding all types of mental distress Psychologists need to be visible and present on the wards and involved in decisions about who would benefit from therapy Wards need dedicated therapy rooms
People with psychosis are not prioritised for therapy as problems, as they are believed to respond to medication	Staff	People with psychosis do not have access to the full range of evidence-based care throughout the care pathway
Integrated care
Psychologist not seen as core members of the multidisciplinary team	Staff	People who might benefit from therapy do not receive it Staff are not exposed to psychological theories of mental distress and do not benefit from the broader support that psychologist can provide to staff teams	Psychologists need to be ward based and frequently present on the wards
Lack of continuity between care on the ward and elsewhere (e.g. community, other services)	Staff Patient Carer	People do not start therapy because of concerns about work not continuing post discharge	Staff need to recognise the value of short-term therapies Staff need to develop good relationships with community teams so psychological formulations and therapies can be handed over
Acute levels of distress
Patients’ acute state of distress affecting what can be offered and adaptations	Staff Patient Carer	People are not offered or do not uptake therapy who might benefit Patients do not know what therapies are available	Psychologists need to be aware of common motivational barriers, including those that might be unique to the in-patient setting and build alliances Therapy may be about containing emotions Psychologists should be based on the ward and talk to staff and patients about what can be provided Staff should talk to carers about what can be provided
Staff capability and motivation
Staff can lack capability and motivation to support psychological therapies	Staff	Staff may not promote therapies to patients Staff may not use the knowledge and skills they do have to engage patients in therapeutic work	Ward staff should have regular training and supervision in psychological models of mental distress and how to deliver low-level psychological interventions (e.g. psychoeducation and coping skills enhancement) Psychologists should build supportive alliances with staff to help understand and overcome motivational barriers