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.