Sleep quality in secure psychiatric healthcare: exploring & supporting inpatient experiences

The prevalence of mental health issues is increasing, globally, with admission rates to inpatient psychiatric facilities higher than ever. Inpatients in secure care often experience comorbid insomnia and poor sleep quality, and the independent impact of sleep problems on mood is well documented. Yet, little is known about how to improve sleep quality for this population, with first-hand accounts of sleep disturbances from this group limited. This thesis aimed to set a foundation to better understand sleep in secure psychiatric healthcare, by investigating the efficacy of current interventions (Chapter Two) and engaging in co-design with stakeholders (Chapter Three) to develop, test, and evaluate a novel sleep quality improvement intervention (Chapters Four-Six).

A systematic review and meta-analysis of sleep interventions for this population found that compared to medical and environmental interventions, behavioural interventions (including use of physical activity) are most effective in improving sleep quality (Chapter Two). Qualitative exploration of inpatient sleep and night-time experiences via staff focus groups and inpatient interviews, conducted at a secure psychiatric hospital (England), identified that inpatients view their bedrooms as their only private space, that irregular sleep schedules are common, that noise and disruption to sleep are common, and that keeping a physically active daytime routine is important (Chapter Three).

As per best practice guidelines, this data was used to design a theoretically informed behaviour change intervention. As it was identified as an effective intervention component, and something which is important to key stakeholders, a physical activity intervention to improve inpatient sleep quality was designed (Chapter Four). The 10-week intervention was tested with a group of adult inpatients (n = 21), where a decrease in insomnia symptoms, a significant advance in sleep phase, and an increase in moderate to vigorous PA were found, pre to post intervention (Chapter Five). Via structured qualitative evaluations with staff and inpatients, the intervention was found to be acceptable, feasible, and effective in improving sleep quality (Chapter Six). The importance of staff-patient rapport was also evident. Though considered a hard-to-reach group, secure inpatient sleep quality can be improved.