Lived experiences of space in secure mental healthcare environments

Focusing on the lived experiences of patients1 and staff within low and medium secure mental healthcare facilities in the UK, the research examines experiences of space
through an exploration of occupants’ affective experiences in these settings.
Whilst a body of research examining healthcare settings exists in the fields of health and environmental psychology, the literature commonly focuses on measurable effects concerning physiological and cognitive responses to environments, with limited focus on embodied experience and meaning making in relation to space. Research examining mental healthcare is also frequently approached from predominantly clinical perspectives and psychosocial research exploring patient perspectives and experiences of inpatient settings is more limited, particularly within secure mental healthcare facilities where occupants may typically be hard to reach.
In the context of limited empirical exploration in relation to everyday experiences in secure mental healthcare environments, the primary aim of the study is to expand understanding of how patients and staff make sense of their affective experiences within low and medium secure inpatient settings and the ways in which these experiences might be spatially mediated. Through investigating how patients and staff inhabit the organisational spaces of institutional care, the research also aims to explore how these institutions can constitute supposedly ‘private’ spaces within their own ‘public’ spaces.
The theoretical grounding to the research integrates a psychosocial process account of experience with a narrative-psychological approach to enable exploration of relationships between space and affective experience in secure mental healthcare services. The research objectives are supported by the chosen qualitative research methodology, which combines a narrative-based approach with visual research methods to access participants’ stories about their experiences and the settings in which they take place.
Nineteen interviews in total were carried out with patients and staff from low and medium secure wards within a large mental healthcare facility in the UK. Semistructured interviewing was used alongside the photographs produced by participants to illustrate the spaces or objects that were relevant to their everyday experiences of the environment and narratives were constructed together with the researcher during the interview. Through this approach, the study explored how participants made sense of their affective experiences within secure mental healthcare environments using narratives that were spatially grounded by their photographs. Following a narrativebased approach to analysis, participants’ stories were interpreted using a conceptual framework of narrative levels of analysis alongside narrative analytic tools to identify spatially situated storylines and significant aspects of the accounts.
Approaching the analysis through the transdisciplinary concept of liminality as a theoretical perspective enabled exploration of how tensions relating to the conflicting priorities and paradoxical functionality of secure settings as both places of carceral containment and therapeutic spaces were experienced through participants’ interaction with the institutional environment. Ongoing relationships between space and experience were observed, alongside engagement with ‘liminal affective technologies’ (Stenner, 2017, 2021) by both patients and staff to manage their affective experiences and distress, including the discomfort of feeling ‘stuck’ in liminal situations. Similarities observed in patient and staff accounts also included experiences of ‘public’ spaces as typically uncomfortable and a wish for more ‘homely’ environments to assist in enabling positive social interaction.