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A qualitative study of Stenhouse (2011) and Barker et al. (1999) revealed the experience of dissonance between the expectations and actual experiences of receiving support from staff in the acute psychiatric ward. Qualitative user-led study of Gilburt et al. (2008) reported that although some participants identified few positive experiences, the majority of them reported numerous negative instances. Factors that users appreciated included being listened, understood and valued. Most individuals described experiences associated with lack or poor communication and

staff unavailability. Many participants also mentioned the negative experiences of coercion, which does not necessarily attribute to the legal aspect of the detention, but to the consequences of it, resulting from the lack of freedom and compulsory treatment, such as a restraint and forcible medication. Coercion was often perceived by patients as ei g ai ashed a d ei g pa t of the ga e – a consequence that even results in disobeying staff. Those that experienced being restrained described it as an assault. Other studies also revealed that when control or discipline are experienced as a th eat to patie ts se se of pe so al f eedo , a ious ou te techniques are employed, such as false obedience and dissimulation or attempts to escape (Letendre, 1997; Steinholtz Ekecntranz, 1995). A study by Mancini et al. (2005) examined the accounts of fifteen adults regarding how they recovered from a psychotic crisis. All participants identified barriers to recovery that included paternalism, coercion and judgmental attitude of professionals. Almost half of the participants also reported side effects of medication being a barrier in the recovery process. Factors that facilitated recovery were identified as supportive relationships and meaningful activities.

Interpersonal relations with staff have often been identified as an essential feature related to patient experience and satisfaction (Stenhouse, 2011; Elbeck and Fecteau, 1990). Research has also demonstrated that meaningful occupation of in-patient wards seems to be a major route to recovery (Collins et al., 1985; College of Occupational Therapists, 2006). It has long been highlighted that in-patient wards, without a clear and maintained focus on treatment, may result in staff operating on a default level and performing tasks routinely, which warrants a mere ward maintenance and can even lead to neglectful and abusive culture (Martin, 1984). Walton (2000) for example characterised wards regarding i stitutio al ai less ess . Some studies focused particularly on patient experience of receiving help in the acute ward. Pejlert et al. (1995) research, for instance, revealed that patients often felt alone during their treatment. The study by Koivisto et al. (2004), on the other hand, suggested that patients felt that their treatment was helpful in terms of alleviating their distress, although unstructured due to the undefined care by ward staff. Thus, it seems that patients had to draw their own conclusions as to what should constitute care. Moreover, care did not seem to reach the inner world of the patients experiencing psychosis. Help and care were construed by patients as offering protection from vulnerability and empowerment to stabilise and restructure their own selves, in order to manage their lives better. Watts and Priebe (2002), on the other hand, found that coercion and imposition of a psychiatric treatment can become an obstacle to the recovery of the patients with psychosis. Similar findings were reported by Thornhill et al. (2004), as the main theme that emerged was the need to escape or endure the unwanted psychiatric treatment. Authors of another qualitative study (Lilja

and Hellzén, 2008, p.1) concluded that the experience of psychiatric inpatient care

could be interpreted (...) as a struggle for dignity in the face of discrimination and rejection . Other qualitative studies on the experience of an involuntary psychiatric

hospitalisation yielded similar results by reporting themes centred on being disrespected as a human being (Olofsson and Jacobsson, 2001), being neglected, ignored and violated. However, positive occurrences have also been identified as regards to being cared for and supported (Johansson and Lundman, 2002; Gault, 2009).

Katsakou and Priebes (2007) thematic analysis reviewed five qualitative studies of involuntary psychiatric care (Olofsson and Jacobsson, 2001; Olofsson and Norberg, 2000; Johansson and Lundman, 2002; Jonesd and Mason, 2002; Quirk et al., 2003). Each of these studies focused on slightly different aspects of the experience and some methodological issues were presented, such as the small sample size, the research aims and questions not being statedclearly. Nevertheless, the findings of the review revealed that on the whole, involuntary admission to an in-patient ward was perceived as negative, although certain positive instances were also described. The main areas that were identified were related to perceived autonomy and participation in the decision-making process, the feeling of being or not being cared for and finally a sense of identity. The review reported that the most common theme is emerging from the data centred on violation of autonomy, rights and influence in their treatment. Participants also described their struggle with the environment that was perceived as strict and occupied with dominating and rigid rules they did not understand. The common thread included the experience of physical violation and coercion, linked to being restrained, segregated or forcibly medicated. The prevalent theme therefore that emerged from this meta-analysis highlighted various losses (of liberty, rights and power) and indicated that the experiences mentioned above could lead to the feeling of failure and powerlessness. Another theme that was identified captured the participant's perceptions of quality of care received which, as reported, tended to colour the overall views on the hospital experience. The review noted that the participants mostly conceptualised their experience of care as pointless or inappropriate and the predominant experience seemed to be that it was deprived of warmth and support of staff competency. Furthermore, on the whole, it seemed that the participants felt that their hospitalisation was not conducive to their well-being, as the main emphasis was on the medication that has adverse side effects; the opportunities for activities were scarce; privacy and personal space were limited, and other patients were frightening, at times. The final theme was also negative and outlined the emotional impact of the hospitalisation, with feelings of being devalued. It has been reported that the common experiences evoking intense emotional response were related to feeling that the professionals were not interested in the patients; were not acceptant of them or were displeased or even irritated with them.

As a result, patients felt rejected and disappointed by the mental health system in general which, induced feelings of hopelessness and pessimism about the future, as well as contributed to lower self-esteem. The study revealed that patients often experienced doubts regarding their own value and worth and felt that they were being treated like criminals and not as a o al health i di idual. E pe ie es of being punished for being ill were also common. Participants described feeling dehumanised and had their integrity violated. Such experiences often lead to the feelings of denigration and stigmatisation, after discharge. In addition, sectioning was also experienced as a ajo dis uptio to o e s life. O the contrary, studies also unravelled some positive experiences. For example, although participants stated an overreaching violation of autonomy, they also reported instances that were characterised by collaboration with health staff and participation in their effective treatment. Furthermore, although the situation was construed as coercive, it also involved times of freedom and flexibility, which was often met with gratification. Moreover, in some cases, participants felt they were being looked after and receiving valuable care. A positive relationship with staff decreased patients se se of insecurity. Equally, connections with other patients or relatives were also deemed important. Finally, some concluded that the hospital was a place of safety and that their hospitalisation was necessary and unavoidable and in some cases, could lead to enhanced self-awareness and beneficial outcomes in the long term. Authors of the meta-analysis reported that although the analysis surfaced both negative and positive experiences, it was unclear whether such instances were described by different patient groups that experienced hospitalisation as negative or positive as a whole, or by the same individuals who managed to identify both drawbacks and beneficial components of their treatment. Furthermore, authors of the review pondered about the characteristics of the patients and whether there is a link to how the involuntary hospitalisation is perceived. It has therefore been pointed out that the differences between distinct groups of patients could be investigated. However, various studies have attempted to explore variables that may be associated with the dissatisfaction levels, which in some cases led to the conclusion that dissatisfied patients are more likel to e, fo i sta e, ou g, si gle, fe ale, pe so alit diso de ed o diag osed with psychosis. These factors, generally speaking, are linked to the more severe and chronic psychopathology. On the other hand, the same meta-analysis studies of socio- demographic factors suggest that higher satisfaction levels are related to greater age, less education, being married, and having higher social status (Hall and Dornan, 1990). However, some studies found no associations between clinical and socio-demographic characteristics (Katsakou and Priebe, 2006; Priebe et al., 2009) and it has been suggested that it is patie ts e pe ie e a d e aluatio s of the t eat e t the e ei e that influences their views (Priebe et al., 2009; Katsakou et al., 2012). However, it appears that yet again, the evidence is gathered from quantitative studies and is inconclusive. Crawfold and Kesse (1999) also argued that the goals of such an

approach are unclear and identify the risk factors for a 'disease, which ultimately implies that a egati e ie s a out the se i es a e the esult of patie ts characteristics and have nothing or little to do with the features of the services they receive.