Carer perceptions of inpatient psychiatric hospitals and the treatment of their loved ones: A meta-review of the literature

BACKGROUND: Inpatient psychiatric admission remains a key intervention in severe mental illness; however, less is known about how informal carers perceive these settings. A meta-review, that is, a systematic review of systematic reviews, was conducted to synthesise factors shaping carers' perceptions of inpatient psychiatric hospitals. METHOD: MEDLINE, PsycINFO and EMBASE were systematically searched for eligible reviews. Methodological quality was appraised using the AMSTAR-2 framework adapted for qualitative evidence, excluding reviews rated "Critically Low." Thematic synthesis was used to detect key overarching factors that generalised across multiple reviews. RESULTS: Seventeen systematic reviews were included, from which five key themes were identified: exclusion and disempowerment; communication and information deficits; emotional and care burden; systemic barriers and crisis-driven pathways and a desire for partnership and collaborative care. CONCLUSION: Carers frequently described experiencing marginalisation, confidentiality being applied in exclusionary ways, as well as fragmented services, particularly around involuntary admission and discharge. Findings highlight modifiable targets for practice, including family-inclusive routines, transparent information-sharing and structured involvement in treatment and discharge planning, which are crucial given the elevated post-discharge suicide risk. Addressing these factors may reduce carer burden, strengthen trust and improve perceptions of quality and safety in inpatient psychiatric care. Limitations of this meta-review and directions for future research are discussed.