Balancing Suicide Prevention Safety, Healing, and Wellness within Inpatient Psychiatric Care: Perspectives about Safety Measures, Unit Design, and Programming

Background and Purpose: Suicide remains a pressing public health concern and inpatient psychiatric units are common places for individuals with suicide thoughts and behavior to engage in care. Therefore, these settings serve as important environments for suicide prevention with opportunities for mental health professionals to assess risk and deliver interventions aiming to reduce risk and suicide outcomes. Although greater focus has been placed on patient safety and unit suicide prevention over the past decades, little research has focused on patients’ perspectives of safety measures and associated impact on the overall healing and therapeutic nature of the psychiatric inpatient environment. Beyond risk management and mitigation, inpatient environments must also aim to foster wellness and therapeutic practices, while simultaneously upholding the dignity and autonomy of patients. This study aimed to explore perceptions and environmental experiences in relation to suicide safety among patients admitted to an adult inpatient psychiatric unit.

Methods: A total of 50 adults within 48 hours of discharge from an inpatient psychiatric unit gave informed consent to engage in a brief survey and qualitative interview with trained research staff. Questions pertained to perceptions and experiences in an inpatient psychiatric environment, with particular focus on public and private spaces on the unit. Clinical and demographic characteristics were explored quantitatively in SPSS, and qualitative data were analyzed using an open coding technique in Dedoose.

Results: Most participants were hospitalized in relation to the experience of suicide ideation or attempt (n=41, 82%). The majority endorsed satisfaction with the healing and or/therapeutic nature of the unit (n=44, 88%), including art programming. Patients overall perceived the unit to be very safe (n=39, 78%) from a suicide prevention standpoint. Qualitative themes that emerged from patient interviews included the unit’s physical/environmental space (e.g., pleasant wall color), patient access (e.g., visitors), programming and policies (e.g., art activities), clinical care (e.g., addressing root issues), unit culture and values (e.g., inclusion), and staff/interpersonal interactions (e.g., attentive staff).

Conclusions and Implications: An overarching aim in this work is to conduct research in this area where there is minimal literature to better align social work science with mental health practice. All themes represent the unit’s values placed on safe expression, comfort, privacy, and agency. Findings emphasize implications that patients validated and appreciated the importance suicide prevention and risk management in inpatient care, in addition to perceived wellness-focused programming to promote both healing and safety, particularly art activities. Inpatient psychiatric units should consider more ways to incorporate wellness-based groups/activities in programming that both enhance the therapeutic and healing experience for patients and help them feel more comfortable from a suicide safety standpoint.