What’s it like? What service user metaphors reveal about experiences of acute mental health inpatient facilities

Metaphors can be rich sources of information about human experience. This article explores the metaphors used by mental health service users to describe their lived experience as service users in acute mental health facilities. Previous studies have identified problems with the environment of such facilities in New Zealand and internationally. Metaphors in 16 transcripts of interviews with New Zealand service users were identified using Cameron and Maslen’s (2010) discourse dynamics approach, to explore their experiences. Systematic metaphors were identified, relating to: Relationships (PASSIVE OBJECTS, AGGRESSORS, WAR); Unit environment (SCHOOL, SEPARATE WORLD, SMALL CONTAINER) and nurses station (SEPARATE CONTAINER); Unit organisation (rules, systems and activities as a SUBSTANCE, time as a MATERIAL RESOURCE, staying in unit as a JOURNEY/END OF JOURNEY); and Experiences of the mind and body (body is a CONTAINER, emotions are MOVEMENT, mind is a BROKEN MACHINE, experience of the unit is PRESSING DOWN). Implications for mental health service user recovery are considered in relation to the Connectedness, Hope and optimism, Identity, Meaning in life and Empowerment and Safety model. Suggestions for improving the models of care and architectural design of acute mental health inpatient facilities that arise from this research include providing choice about meaningful ward activities; staff working more collaboratively around decision-making; more open ward designs, with more community connection; increasing homely touches such as cushions; thorough service user orientation on admittance; time outdoors and providing emotion regulation training in groups.