Experiences of Voluntary Psychiatric Admissions to Acute Wards in East London: An Interpretative Phenomenological Analysis

Background: Voluntary Psychiatric admission was introduced almost a century ago and has become an increasingly popular method of admission, aiming to promote patient autonomy within the admission experience. A burst of literature
over the last decade indicates that, contra to this aim, experiences of coercion and injustice are common in voluntary admission. However, relatively little research explores the individual’s nuanced experience and understanding of
these admissions in depth.
Aims: To explore patient understandings of their experience of voluntary admission, the concept of “voluntary”, and how these understandings change over time.
Method: Five female participants were recruited from acute psychiatric wards and completed a semi-structured interview within eight weeks of discharge from a voluntary psychiatric admission. Interviews were transcribed and analysed
using Interpretative Phenomenological Analysis.
Findings: Three themes were generated to describe participant’s understanding of their experience of voluntary admission: Need, Boundaries, and Identity. Participants experienced admission through needs of safety and
validation, and whether these were met. Whilst dialogue, inclusion, and trust facilitated meeting these needs, coercion and inconsistent boundaries led to experiences of powerlessness and mistrust which prevented needs being met.
Stigma was implicated in perpetuating experiences of judgement and negative sense of self on the wards. Being “voluntary” was associated with increased freedom, choice and agency, creating the possibility of experiencing empowerment in admission. However, it also invited comparisons and promoted “othering” between patients on wards which led to experiences of both gratitude and fear.
Implications: The findings promote the need for increased dialogue during admission, further transparency of information about patient rights and employment of practices which reduce the impact of stigma on wards. This increased dialogue and understanding, may serve to increase feelings of safety and validation on the ward and help to harness the opportunity given through voluntary admission for positive experiences of empowerment and change.