Service Users’ Experiences of “Paranoia” on Psychiatric Wards

Background: Research suggests that admission to an inpatient psychiatric ward can have a detrimental impact on service users’ mental health and may give rise to distressing and traumatising experiences. However, there has been limited exploration or conceptual development regarding how or why this may occur, and what the emotional response to these experiences may be. Paranoia can be conceptualised as an emotional threat response to anxiety-provoking and unsafe environments. Consequently, the current study aims to fill a gap in the literature by considering how admission to a psychiatric ward may give rise to experiences which lead people to feel unsafe, threatened, suspicious and paranoid.
Aim: This study aimed to explore what service users perceive to be the factors which influence their experience of paranoia on psychiatric wards and therefore consider what services could do differently to alleviate experiences of paranoia.
Methods: Eight semi-structured interviews were conducted with service users who had previously accessed inpatient psychiatric services. Transcripts were analysed using Thematic Analysis.
Results: The current study found that service users’ experiences of paranoia during admission to inpatient psychiatric wards were influenced by five overarching themes: (1) feeling disbelieved, persecuted, stigmatised and discarded (2) feeling unsure of what was going on (3) experiencing the ward as an unsafe place to be (4) paranoia as a coping mechanism and (5) moments of care and connection. A description of these themes and accompanying subthemes is presented.
Conclusion: The findings indicate that a range of factors can influence service users’ experiences of paranoia on inpatient psychiatric wards which can lead to mistrust of the mental health system, staff, and other service users. The findings also highlight that certain factors can alleviate paranoia and support a positive inpatient experience. Results have implications for policy, practice, and Clinical Psychology, and support the incorporation of paranoia-reducing practices into Trauma-Informed Care approaches implemented on inpatient psychiatric wards.