Being admitted to a mental health unit can be one of the most vulnerable moments in a person’s life. They often arrive in the midst of a crisis, and are fearful, confused and anxious. But in these situations, one thing can profoundly affect their experience: the relationship established with the nurses who attend them, especially in the first days.
While it may seem secondary to medical treatments or clinical decisions, the therapeutic relationship – meaning the collaborative bond between patient and nurse – has a greater impact than previously thought.
Our study, carried out in 12 Spanish mental health units, demonstrated that this relationship is not always built in the way we might think.
An uneven start
We analysed how both patients and nursing professionals perceived the therapeutic relationship in the first days after a patient was hospitalised. The results were significant. While nurses tended to positively evaluate the relationship, patients were less satisfied. There was a gap between how the care was perceived and how that care actually felt for those receiving it.
There are three key reasons for this difference: communication, trust and participation. Patients especially value feeling heard, understanding what is happening to them and, above all, having a say in decisions about their treatment.
It is not just a question of receiving attention, but of playing an active role in the whole process. One of the most important things for patients is a clear agreement on the goals and means of treatment. When this does not happen, the therapeutic relationship suffers from the outset.
Treatment is not just technical
In our second study, we analysed the experiences of over 250 patients upon being admitted to hospital. We wanted to understand their experiences of being admitted, and what factors influenced it.
The results were clear: the better the patient’s perception of their treatment, the less coercion, humiliation and fear they felt. This is especially important in mental health units because patients often experience certain situations – even those which are clinically justified – as being imposed on them.
However, our data show that the feeling of coercion does not depend solely on the measures applied, but on the context in which they occur and how professionals relate to patients. Aspects such as having private spaces, feeling safe within the unit, receiving emotional support and participating in decisions about treatment all play a decisive role.
In other words, it is not just a question of what is done, but how it is done. The same procedure can be experienced as help or an imposition, depending on the relational quality of the patient’s surroundings.
Improving hospitalisation
As part of this study, we asked ourselves a key question: is there a specific intervention that would improve the therapeutic relationship and, with it, patients’ experiences?
To answer this, we designed a simple but structured intervention: the “Reserved Therapeutic Space”. It consists of designated moments during hospital admission where the nurse and the patient meet without interruption to identify concerns, agree on goals, and monitor the overall process.
It does not aim to add more tasks, but to ensure something that is often lost in the care routine: quality time for communication.
The results were conclusive. Patients who received this intervention showed significant improvement in the therapeutic relationship. They perceived a higher quality of care, especially in key areas such as participation and preparation for discharge.
We observed one especially significant effect: these patients experienced fewer feelings of coercion, humiliation and fear during their admission. In other words, something as apparently simple as having a structured space for conversation and collaboration significantly reduces the negative experiences associated with hospitalisation.
And the effects do not stop there.
One of our most striking findings was that patients who participated in this model were discharged earlier than those who received usual care. On average, their hospital stay was reduced by several days.
This suggests that the therapeutic relationship not only influences how admission is experienced, but also clinical progression itself.
More effective care
Traditionally, the relationship between health workers and patients has been considered a “human” or “ethical” dimension of care – something important but difficult to measure. Our results challenge this. The way staff relate to patients has measurable effects on patients’ emotional experiences, their sense of security, their participation in treatment and, ultimately, their recovery.
This means that listening, conversing, agreeing objectives and building trust are not just add-ons to treatment – they are an essential component of it.
Our findings also have major implications for healthcare systems searching for ways to improve efficiency, reduce hospital stays and optimise their resources.
Improving care is often thought of as introducing new technologies or increasing the intensity of treatments. But sometimes, the most transformative change is much simpler, and involves guaranteeing that the person being cared for has a space where they are listened to, understood, and recognised as central to their own treatment.
The evidence is clear. When people participate, trust and feel respected, they have a better experience of hospital admission and a better recovery. And in mental health, this can make a world of difference.
A weekly e-mail in English featuring expertise from scholars and researchers. It provides an introduction to the diversity of research coming out of the continent and considers some of the key issues facing European countries. Get the newsletter!
