"Set up to Fail": Staff Experiences of Caring for Long-Stay Patients in Acute Mental Health Wards in England

Sambrook, L ORCID: 0000-0002-4798-9536, McIntyre, JC, Nathan, R, Bifarin, O ORCID: 0000-0002-8247-2508, Wilson, P, Humphreys, M, Tait, J, Ashley-Mudie, P and Saini, P (2026) "Set up to Fail": Staff Experiences of Caring for Long-Stay Patients in Acute Mental Health Wards in England. International Journal of Mental Health Nursing, 35 (3). ISSN 1445-8330

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Abstract

Rising demand for mental health services worldwide has placed increasing pressure on acute inpatient services, where patient lengths of stay continue to grow. Long-stay admissions (> 60 days) are linked to demographic, diagnostic and service-related factors, with the United Kingdom reporting longer stays than other developed countries. National reforms aim to reduce unnecessary inpatient stays, but staff report high strain and burnout within current systems, reflecting systemic issues such as inadequate community support and limited discharge options. We aimed to examine staff experiences of working on acute mental health inpatient wards, focusing on long-stay patients, to drive improvements in care quality and workforce sustainability. Six focus groups were conducted with a range of clinical staff working on acute wards (n = 34). Themes were generated using inductive, reflexive thematic analysis, focusing on semantic content while also considering latent meanings. The following key themes were identified: (1) Structural and systemic conditions shaping care delivery, (2) Organisational processes constraining patient flow, (3) Emotional labour and burnout among staff, and (4) The cycle of institutionalisation and dependency. The findings evidenced that acute wards are under significant pressure, with long stays, delayed discharges, and repeat admissions driven not only by clinical need but also by gaps in housing, community services, and care coordination. Addressing these challenges requires investment in workforce development, stronger inter-agency collaboration, and expanded community provision, enabling acute wards to fulfil their intended role as short-term, recovery-focused settings that provide person-centred care for people in crisis.

Item Type:	Article
Uncontrolled Keywords:	Humans; Length of Stay; Focus Groups; Attitude of Health Personnel; Burnout, Professional; Mental Disorders; Adult; Psychiatric Department, Hospital; England; Female; Male; focus groups; inpatients; length of stay; mental health; psychiatric; qualitative research; Humans; England; Length of Stay; Psychiatric Department, Hospital; Burnout, Professional; Focus Groups; Attitude of Health Personnel; Mental Disorders; Male; Female; Adult; 1110 Nursing; 1117 Public Health and Health Services; 1701 Psychology; Nursing; 3904 Specialist studies in education; 4203 Health services and systems; 4205 Nursing
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RT Nursing
Divisions:	Nursing and Advanced Practice
Publisher:	Wiley
Date of acceptance:	8 May 2026
Date of first compliant Open Access:	26 May 2026
Date Deposited:	26 May 2026 15:51
Last Modified:	26 May 2026 15:51
DOI or ID number:	10.1111/inm.70271
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28655

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