Individuals who report experiencing negative or harmful effects during psychiatric hospitalization—such as concerns about care being minimized or hearing serious news delivered in an insensitive manner—are less likely to trust mental health providers afterward and less likely to participate in follow-up care or undergo voluntary hospitalization, according to a report in Psychiatric Services.
Such experiences of “institutional betrayal” are also more likely to be reported by patients in for-profit facilities, according to the study.
“Institutional betrayal occurs when an institution creates an environment where harm is likely to occur or when the institution normalizes, minimizes, or fails to respond to reports of harm,” wrote Alicia Lewis, B.S., of Washington University in St. Louis, and colleagues.
Lewis and colleagues surveyed 814 adults who had been treated in any adult psychiatric inpatient unit in the United States between 2016 and 2021, collecting data on patients’ demographics, experiences of institutional betrayal, and the impact of psychiatric hospitalization on their engagement with mental health care post-discharge. The researchers used the Institutional Betrayal Questionnaire to identify various types of institutional betrayal and linked responses to data on facility ownership type.
Among respondents whose inpatient facility could be identified, 27% were admitted to a for-profit hospital, 15% to a government hospital, and 57% to a nonprofit hospital.
More than one-third of the sample (38%, N=307) had not experienced a betrayal, 38% (N=308) had experienced one to five types of betrayal, and 25% (N=199) had experienced more than five types of betrayal. Compared with individuals who had not experienced institutional betrayal, those who did were:
- 25% more likely to report that the hospitalization had reduced their trust in mental health providers.
- 45% more likely to report a reduced willingness to voluntarily undergo hospitalization in the future.
- 30% more likely to report a reduced willingness to disclose future distressing thoughts to a mental health provider.
- 11% less likely to report having a 30-day post discharge follow-up visit.
Compared with participants hospitalized at a nonprofit facility, those who were hospitalized at a for-profit facility were 14% more likely to report having experienced an institutional betrayal.
“…[P]olicy makers and payers need to more closely monitor the impact that profiteering might have on care quality and should identify ways to … better support patients’ well-being and outcomes,” the researchers wrote. “[S]urveying people on the extent to which they felt respected and supported during their inpatient hospitalization and providing these metrics to the public could be an important step in incentivizing a high quality of care.”
For more information, see the Psychiatric News article “Study Identifies Adverse Event Factors Linked to Psychiatric Hospitalization.”
(Image: Getty Images/iStock/Nastco)
Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.
