What are the experiences of people with psychosis, their carers and staff in inpatient mental healthcare services in the United Kingdom? A systematic review and meta‐ethnography

BACKGROUND: UK inpatient mental healthcare services face ongoing challenges of safety and staff shortages. People experiencing psychosis account for around half of admissions, with over half readmitted within 7 years. Care is organized around the therapeutic alliance between patients, their carers and staff, yet no systematic review has synthesized the views of all three groups within UK inpatient settings. AIMS: (i) To identify and appraise qualitative studies examining experiences of inpatient mental healthcare from the perspectives of patients with psychosis, carers and staff; (ii) To synthesize findings to deepen understanding of these experiences: METHOD: A systematic search of three databases identified 21 relevant studies. All were appraised using an adapted Critical Appraisal Skills Programme (CASP) tool. Data were extracted and synthesized using meta-ethnography. RESULTS: Study quality varied. Three key constructs emerged: (1) Power and Control in the Inpatient Setting; (2) Atmospheres of Care and (3) Connection and Recovery. Patients, carers and staff described multifaceted challenges within conflict-laden environments. Experiences ranged from confusion, disconnection, and threat to safety, understanding, and recovery, shaped by relational and communicative practises. Where patients felt informed, carers included and staff supported, experiences were more positive. Conversely, institutional routines may function as defences against emotional strain, risking relational detachment. CONCLUSIONS: Inpatient services support individuals experiencing acute distress and risk, underscoring the emotional intensity of these settings. Despite policy emphasis on deinstitutionalization, inpatient care remains essential. Future research should further explore staff and carer experiences to inform relationally attuned service design.