‘Treating this place like home’: An exploration of the notions of home within an adolescent inpatient unit and subsequent implications for staff training.

Abstract

Notions of home are deeply rooted in our sense of self. This qualitative research explores how young people, their families and the staff on a psychiatric adolescent inpatient unit construct meaning around the notion of home. Given that admissions can range between a few days to many months, understanding what young people, families and staff actually understand the unit to be; home, hospital or something else, will have significant clinical implications. The research elucidates how these groups talk about home generally, and the adolescent inpatient unit specifically as 'home' and a secure base. As a researcher and systemic family psychotherapist, I conducted eleven focus groups with staff, young people and families on a general adolescent inpatient unit. Two autoethnographic interviews were also conducted and the data were then all scrutinised using a discourse analysis, drawing on both systemic theory and attachment theory. This research suggests that discourses around role confusion, safety and the embodiment of home, attachment relationships and the contradictory positions of home or hospital were evident for all participants and have been hitherto undertheorised in this context. Inherent contradictions between focus groups were highlighted; for the young people the unit is where they live, for the staff, it is ‘work’ and for the parents, it is where their young people go away from home. The research concludes that theories such as the reciprocal nature of attachment relationships, iatrogenic injury, the therapeutic milieu and attachment ruptures between young people and parents have a profound impact on an inpatient admission and are often unspoken and underoperationalised. Clinical recommendations are made about managing the dilemmas associated with the unit becoming a home, and the subsequent training needs of inpatient staff.