{"id":"https://openalex.org/G2277458562","display_name":"An investigation of therapeutic alliance and its relationship to service user satisfaction in acute psychiatric wards and crisis residential alternatives","description":"Acute inpatient services are a very important part of mental health services, both because people are admitted to them, sometimes against their will, at times when their needs and distress are often great, and because they are a costly part of the NHS\u2019s services. We do not have much good research evidence available about what makes them work well, but service users often report that they find them unsatisfactory. A substantial number of community-based crisis residential services, often called crisis houses, have been set up in the UK. They aim to provide an alternative to hospital admission for people at times of mental health crisis. A recent NHS-funded study found that patient satisfaction was greater at community-based crisis houses than on acute inpatient wards in the same areas. However the study could not fully explain this greater satisfaction. It did not seem to be due to differences in how well service users recovered, in the amount of staff-service user contact, or in types of care provided. In-depth interviews suggested that the quality of patients\u2019 relationships with staff was key to their experience in hospital or alternative crisis services.\r\n\r\nThis study builds on this recently completed study in investigating what influences staff-patient relationships and patient satisfaction with acute inpatient and residential services. We will test whether, as the qualitative interviews in the initial study suggest, therapeutic relationships are stronger in crisis houses than in hospital. We will collect data from four non-hospital crisis houses and four acute inpatient wards in London. We will use questionnaires with about 100 crisis house residents to measure their therapeutic alliance (the quality of their relationship) with key staff involved in their care and their satisfaction with services. We will also measure some other factors that may be related to patient satisfaction, including their perceptions of their own recovery and experiences of negative events during admission. We will compare these data with data using the same measures collected from patients in acute wards in another recently funded study that we are conducting (this overlap between the studies allows us to collect the data we need more economically). We will compare therapeutic alliance at crisis houses and inpatient wards and explore how this and the other factors measured relates to patient satisfaction. We will also conduct in-depth qualitative interviews with a smaller number of patients and with some staff members (32 patients and 16 staff). These will explore views about what factors promote and impede development of good relationships between patients and staff, focusing especially on the environmental, organisational and managerial contexts and on potential strategies for improving relationships.\r\n\r\nThe study will be designed to address the ethical concerns about involving patients in research during a period of mental health crisis. Staff at each service who know the patients will advise whether each patient is able to give consent and understand what the study involves. Only those able to make an informed decision about taking part in the study will be approached. Researchers will seek to recruit patients close to the time when they leave the service, when they are most likely to be well. Staff from the service will make the initial approach. Service user-researchers will be recruited and trained to conduct the in-depth interviews with patients, to try to ensure they feel at ease and able to speak candidly. The approach used in this study is based on previous studies in acute inpatient settings in which members of the research team have been involved. The study will help assess the value of community alternatives to inpatient care, providing service planners and managers with new information to guide decisions about whether and how to implement the model. It will also generate new ideas about how relationships between staff and patients c","funder_award_id":"09/1001/51","funder":{"id":"https://openalex.org/F4320319990","display_name":"National Institute for Health and Care Research","doi":"10.13039/501100000272"},"funded_outputs":["https://openalex.org/W2142018915"],"funded_outputs_count":1,"parent_awards":[],"sub_awards":[],"sub_awards_count":0,"amount":129244.0,"currency":"GBP","amount_usd":207332.89,"amount_usd_basis":"daily_rate","recipients":[],"recipient_countries":[],"recipient_regions":[],"research_scope":{"is_research":true,"basis":"funder_default","tier":1},"funding_type":"research","funder_scheme":"Health and Social Care Delivery Research","start_date":"2011-04-01","end_date":"2012-11-30","start_year":2011,"end_year":2012,"landing_page_url":"https://fundingawards.nihr.ac.uk/award/09/1001/51","doi":null,"provenance":"nihr","lead_investigator":{"given_name":"Isabella","family_name":"Johnson","orcid":"0000-0002-2219-1384","role_start":null,"affiliation":{"name":"University College London","country":"Award does not have an ODA Downstream Partner","ids":null}},"co_lead_investigator":null,"investigators":null,"works_api_url":"https://api.openalex.org/works?filter=awards.id:G2277458562","primary_topic":{"id":"https://openalex.org/T13944","display_name":"Psychiatric care and mental health services","score":0.9232,"subfield":{"id":"https://openalex.org/subfields/3203","display_name":"Clinical Psychology"},"field":{"id":"https://openalex.org/fields/32","display_name":"Psychology"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T13944","display_name":"Psychiatric care and mental health services","score":0.9232,"subfield":{"id":"https://openalex.org/subfields/3203","display_name":"Clinical Psychology"},"field":{"id":"https://openalex.org/fields/32","display_name":"Psychology"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"institution_awarded":[{"id":"https://openalex.org/I45129253","display_name":"University College London","ror":"https://ror.org/02jx3x895","country_code":"GB","type":"education","lineage":["https://openalex.org/I124357947","https://openalex.org/I45129253"]}],"updated_date":"2026-10-16T03:01:01.000Z","created_date":"2026-07-13T04:27:59.000Z"}