Identifying Barriers and Facilitators to Providing Psychologically Safe Care in Inpatient Mental Healthcare. A Theoretical Domains Framework‐Informed Qualitative Study

AIM(S): To explore the facilitators and barriers to staff providing psychologically safe care in inpatient mental healthcare when restrictive practices are used. DESIGN: Qualitative descriptive interview study. METHODS: Twenty semi-structured interviews were conducted with staff with experience working in inpatient mental healthcare in England. Analysis included principles of framework analysis, informed by the Theoretical Domains Framework. RESULTS: Access to resources and a safe environment for both patients and staff were recognised as important (environmental context and resources) but access was impacted by competing organisational priorities and expectations (beliefs about capabilities). Participants recognised knowledge gaps in themselves and their colleagues (knowledge). Being able to confidently make decisions about risk was seen as central to the staff role (social/professional role and identity). Collaboration between staff is needed to make positive change and progression towards psychologically safe care (social influences). Empathy and compassion were driving factors in participants trying to use psychologically informed alternatives, but burnout hindered this (emotions). CONCLUSION: Ensuring that staff feel supported in their role to implement psychosocial informed alternatives to restrictive practices, as well as providing safe environments for both patients and staff, could support the integration of psychologically safe care on inpatient mental health wards. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Key facilitators and barriers to staff providing psychologically safe care are identified to support practice and improvements to patient care. REPORTING METHOD: Consolidated criteria for reporting qualitative studies (COREQ). PATIENT OR PUBLIC CONTRIBUTION: Former patients and members of the public were involved in the conceptualisation of key concepts and design of this study.