The mealtime experiences of adults with mental illness living on inpatient wards

Background: Dysphagia, its associated risk of choking, and the impacts on quality of life, are serious concerns for people with mental illness and their caregivers. Prior research has highlighted the prevalence of premature, preventable death from choking on food and the consequences of dysphagia on physical health. However, there is little known about the lived experience of dysphagia and choking for people with non-organic mental illness.
The aim of this study was to explore patients’ perspectives of mealtime experiences on inpatient wards to improve understanding of dysphagia and risk of choking.

Method:
This thesis presents an integrative literature review which drew attention to the medicalised perspectives in existing research regarding dysphagia and risk of choking in working age adults with non-organic mental illness. Thematic analysis highlighted a lack of information on patient experiences, insight and inclusion in the literature confirming the need for further research.
Consultation with patients and caregivers involved discussing the literature review themes and then co-designing interviews to investigate patients’ perspectives of mealtime difficulties. The interviews included patients, staff, and speech and language therapists. Reflexive thematic analysis constructed themes relating to the heightened emotions associated with inpatient mealtimes.

Findings:
Patient perspectives included themes of connections, autonomy, and the impact of stressful mealtimes on swallowing. Staff and speech and language therapists also presented insights on negative mealtime experiences and the impact on mental health recovery.

Conclusions:
Synthesis of the themes raised important questions for patients’ recovery and clinical practice. The stressful nature of mealtimes appeared counter to patients’ wellbeing and recovery and impacted negatively on staff’s and speech and language therapists’ practice. Inpatient mealtimes are a missed opportunity to promote mental health recovery, build patient skills, and raise staff morale. There is clear need for further research into adapting and improving mealtimes on mental health wards.