Psychiatric hospital experiences that support and frustrate emerging adults' psychological needs: A self-determination theory perspective.

AIM: There are international efforts to implement developmentally appropriate and youth-oriented mental health services for emerging adults to increase treatment engagement and the success of early intervention. While significant progress has been made in developing community service models, limited research has focused on how to design psychiatric inpatient settings that promote the recovery of emerging adults. The present study attempts to address this knowledge gap through a qualitative exploration of hospital experiences that influence psychological need satisfaction and frustration, as defined by self-determination theory (SDT). METHODS: Inpatients (N = 104) from an emerging adult psychiatry unit were interviewed regarding hospital experiences that related to satisfaction or frustration of SDT needs for autonomy, competence, and relatedness. RESULTS: A basic interpretative qualitative analysis highlighted six key aspects of the hospital experience relevant to these needs: (a) social interactions, (b) freedom of behaviour and access, (c) programs and activities, (d) treatment collaboration and choice, (e) restraining/unpleasant hospital practices, and (f) progress, symptoms, and functioning. The findings support SDT's emphasis on the importance of autonomy support, structure, and involvement for need satisfaction. CONCLUSIONS: The study sheds light on aspects of the hospital milieu that may be essential to recovery-oriented inpatient care and on experiences that may be distinctly important for emerging adults, such as support for independence and the opportunity to relate to same-age co-patients experiencing similar mental health problems and life circumstances.

Identification of psychiatric inpatient recovery trajectories using routine outcome monitoring with emerging adults.

Early intervention for emerging adults with addiction and mental health disorders is beneficial for long-term recovery. The present study investigated the utility of routine outcome monitoring during acute inpatient hospitalization for identifying emerging adults at risk of poor outcomes. This is a retrospective study using latent class growth analysis (LCGA) to identify patient groups with different recovery trajectories, with additional analyses to clarify the characteristics of these trajectory groups. The results identified four patient groups: Rapid responders (38%), gradual responders (34%), high distress non-responders (9%), and low distress non-responders (19%). The high distress non-responding group is characterized by behaviours and disorders associated with ambivalent care seeking: Voluntary admission, longer length of stay, lower service satisfaction, higher outpatient service utilization, elevated risk of emergency department presentation and hospital readmission, and depression/personality disorder diagnosis. The low distress group is characterized by behaviours and disorders associated with treatment rejection: Involuntary admission, shorter length of stay, reduced post-discharge service utilization, and psychotic disorder diagnosis. The results have implications for identifying at-risk youth and developing stepped-care models for more effective and efficient inpatient care.