Waking up to sleep in secure mental health services

White crumpled blankets
Photo by Krista Mangulsone on Unsplash

On a basic level, all humans really need to survive is air, water, food and sleep. We need to sleep every night to give our body important R&R, among many other things. And research has shown how getting a good night’s sleep is crucial for our mental health and wellbeing.

When we sleep well, we’re more likely to have greater concentration, be in a better mood and get things done. In contrast, when we don’t, we can really see and feel the opposite effect. While we all have a poor night’s sleep from time to time, we know that people in prison and forensic mental health hospitals in the UK struggle more than most. Yet sleep has seemingly stayed off the radar and isn’t prioritised in these areas.

That’s why we believed it was important to get together and tell people in these settings about the importance of sleep. We also wanted to inform our brand-new research proposal on managing sleep problems better in secure environments.

Giving importance to sleep in a secure hospital

Our research group originally came together after the Forensic Aspects of Sleep: Research and Development conference in Middlesbrough. We applied for and won around £10,000 from the NHS Research Capability Funding to establish a new cross-disciplinary forensic research group.

The resulting team is a collaboration between Tees, Esk Wear Valley (TEWV) NHS Foundation Trust, University of York and Imperial College London. People in our group have varied professional and lived experiences, including psychiatry, clinical academia, sleep, senior psychiatric nursing and service users. We’ve met five times in the last year in a medium secure hospital in Middlesbrough, where we recently held an event to engage the public about sleep.

The sleep research group
Our research group (Lindsay third from left)

Engaging inpatients in sleep

On 21st January 2020, we ran a half-day forensic sleep public engagement event within the secure grounds of the forensic psychiatric hospital. We wanted to increase awareness of the importance of sleep to TEWV staff, but also to include as many voices as possible in taking our work forward to inform our research.

The event brought together patients, clinicians, senior managers and commissioners. We set up four different areas that people were free to explore. These were: 1) our research group’s journey so far, 2) how we measure sleep, 3) why sleep is important and 4) Imperial’s ‘People’s Research Café’ to inform our next steps.

The Café gives people the chance to meet researchers and exchange ideas on projects, and it was the first time it had been run in a secure environment. Both patients and staff really engaged with this activity. Once they relaxed, and got going, they couldn’t wait to tell us about issues related to getting a good night’s sleep in the hospital and how we could use research to improve patients’ sleep. One of the main issues raised was the amount of noise. Noises ranged from the window slats being opened every hour at night for safety checks, to staff talking at night unaware their voices echoed down the corridor.

Lindsay and a colleague at the sleep workshop
Lindsay (left) with Amanda hosting the Café.

A huge success

Post it notes from the sleep workshop
Feedback from the event

We expected there to be numerous barriers to conducting this event in the secure hospital because of the hospital security regulations. But thanks to considerable prep work and discussions with the security staff, many things we anticipated could raise problems weren’t an issue. For example, pens were counted before and after the event, we used sticky Velcro rather than Blu Tac to reduce security risks and we all had to be escorted within the setting.

The feedback from the attendees and our team shows the event was a huge success. Everyone said the event was helpful for learning something new about sleep, with people describing it as “informative”, “engaging” and “interesting”. Reflecting on the event, Dr Amanda Perry from the University of York said, “Talking to patients and staff over coffee was an opportunity to share ideas, worries and challenges in relation to the management of sleep in secure environments. Everyone I spoke to had a vested interest in making sleep better for all patients in this environment.”

Dr Anne Aboaja, Forensic Psychiatrist at TEWV NHS Foundation Trust and Forensic Sleep Research Group lead said, “The People’s Research Café experience was successful, and it was great to learn about this methodology.”

Next steps

We will now collate everything we learnt from the People’s Research Café into usable data to inform our research grant proposal. We’re currently writing a commissioned piece of work on the topic of sleep in mental health settings for the journal BJPsych Advances and conducting a scoping review on sleep interventions for the same setting. Our protocol is under review at JBI Evidence Synthesis.

We also hope to hold a similar in the future but covering multiple smaller research projects in one go. We’re excited about the next steps in this relatively new field and will continue to work with patients and staff so that what we do is informed by and tailored to their needs.

Dr Lindsay Dewa is a Research Associate in IGHI’s Patient Safety Translational Research Centre

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