Boredom proneness in a psychiatric inpatient population

High state boredom vastly affects psychiatric inpatients and predicts their treatment duration

Boredom is a ubiquitous, aversive human experience typically elicited by low information and monotony. Boredom can occur either as a transient mental state that prompts individuals to adapt their behavior to avoid monotony or as a temporally stable trait, describing a chronic susceptibility to feeling bored. Increased trait boredom was found to correlate with various psychopathologies and indicators of mental burden. However, the role of state boredom in psychopathological conditions and its implications for psychiatric treatment remain elusive. Here, we address this issue by investigating state boredom and trait boredom in a cohort of psychiatric inpatients and a healthy control cohort. We find that in both groups, state boredom, even more than trait boredom, shows remarkable associations with psychopathology. In the inpatient group, state boredom is implicated broadly in multiple mental disorders and shows an association with treatment in closed psychiatric wards. Furthermore, through statistical modeling, we find that high-state boredom during inpatient therapy is predictive of a longer therapy duration. Thus, we show that state boredom constitutes an indicator of mild and severe psychopathology in different mental disorders, affecting the outcome of psychiatric patients. Potential therapeutic interventions are discussed, aiming to enhance information flow in the brain in order to alleviate boredom in clinical settings.

Scoping Review of Cannabis-Reduction Psychosocial Interventions and Reasons for Use among Young Adults with Psychosis

Objective: No evidence-based intervention effectively reduces cannabis use in young adults with psychosis (YAP). To generate hypotheses about why, a scoping review was conducted to synthesize evidence about motivations for cannabis use and reduction/cessation for YAP and the psychosocial interventions trialed to identify possible gaps between motivations and interventive strategies. Methods: A systematic literature search was conducted in December, 2022. Reviews of titles and abstracts (N = 3,216) and full-texts (n = 136) resulted in 46 articles. Results: YAP use cannabis for pleasure, to reduce dysphoria, and for social and recreational reasons; motivations for cessation include insight about cannabis-psychosis interactions, incompatibility with goals and social roles, and support from social networks. Interventions with at least minimal evidence of efficacy include motivational interviewing, cognitive-behavioral strategies, and family skills training. Conclusions: Authors recommend additional research on mechanisms of change and motivational enhancement therapy, behavioral activation, and family-based skills interventions matched to YAP motivations for use/cessation.

Participating in Longitudinal Observational Research on Psychiatric Rehabilitation: Quantitative Results From a Patient Perspective Study

BACKGROUND

Longitudinal observational studies play on an important role for evidence-based research on health services and psychiatric rehabilitation. However, information is missing about the reasons, why patients participate in such studies, and how they evaluate their participation experience.

METHODS

Subsequently to their final assessment in a 2-year follow-up study on supported housing for persons with severe mental illness, n = 182 patients answered a short questionnaire on their study participation experience (prior experiences, participation reasons, burden due to study assessments, intention to participate in studies again). Basic respondent characteristics as well as symptom severity (SCL-K9) were also included in the descriptive and analytical statistics.

RESULTS

To help other people and curiosity were cited as the main initial reasons for study participation (>85%). Further motives were significantly associated with demographic and/or clinical variables. For instance, "relieve from boredom" was more frequently reported by men and patients with substance use disorders (compared to mood disorders), and participants 'motive" to talk about illness" was associated with higher symptom severity at study entry. Furthermore, only a small proportion of respondents indicated significant burdens by study participation and about 87% would also participate in future studies.

CONCLUSIONS

The respondents gave an overall positive evaluation regarding their participation experience in an observational study on psychiatric rehabilitation. The results additionally suggest that health and social care professionals should be responsive to the expectations and needs of patients with mental illness regarding participation in research.

Doing nothing? An ethnography of patients' (In)activity on an acute stroke unit

Health research has begun to pay increasing attention to inactivity in its broadest sense as lack of meaningful activity and boredom. Few studies however have taken a critical look at this phenomenon. We explore (in)activity drawing on ethnographic data from observations in an acute stroke unit and post-discharge interviews with stroke survivors and their families. Four themes emerged that explain patients’ (in)activity: (i) planned activities; (ii) ‘doing nothing’, (iii) the material environment of the unit; (iv) interactions with staff. Considering these themes, we seek to problematise received conceptual and methodological approaches to understanding (in)activity. We argue that (in)activity is best conceived not as lack of action or meaning, but as a situated practice encompassing both bodily and mental activities that reflect and reproduce the way in which life is collectively organised within a specific healthcare setting.

Patients' Views With Regard to Personal Recovery in Forensic Psychiatry in German-Speaking Switzerland-An Explorative Study

Recovery orientation (RO) is a modality of supporting patients to improve self-determination, leading a meaningful life and well-being in general. This approach is widely studied in general psychiatry, but evidence is lacking for forensic inpatient settings in Switzerland. While secure forensic clinics tend to be regarded as total institutions, which are an anathema to RO, a project to implement RO interventions in this setting was financed by the Swiss Federal Office of Justice. This explorative study investigates baseline expectations and views of patients in forensic wards in German-speaking Switzerland in the context of a recovery-oriented intervention. As such wards are non-existent in Latin-speaking Switzerland, the investigation could only be carried out in this language region. Six focus groups with 37 forensic inpatients were conducted. Thematic analysis revealed two major and several subthemes. The major theme "heteronomy" includes the subthemes "stigmatization and shame," "coercion," "lack of support," "mistrust," "waiting," and "structural impediments." The subthemes "learning to live with the disorder and working on oneself," "participation," "connectedness," "confidence," and "joie de vivre" belong to the major theme "regaining self-determination." In this way, results of prior research are extended to forensic peculiarities. Furthermore, the personal views of patients are discussed in detail regarding their possible influence on therapeutic outcomes and personal recovery. These findings should be of help to therapeutic staff in the respective setting to be better informed about, and to counter the effects of, heteronomy and long-term hospitalization. Important in this regard is the concept of procedural justice and the subjective client's perception thereof.

What is the best way of delivering virtual nature for improving mood? An experimental comparison of high definition TV, 360° video, and computer generated virtual reality

Exposure to 'real' nature can increase positive affect and decrease negative affect, but direct access is not always possible, e.g. for people in health/care settings who often experience chronic boredom. In these settings 'virtual' forms of nature may also have mood-related benefits (e.g. reducing boredom) but it has been difficult to separate effects of nature content from those of delivery mode. The present laboratory-based study explored whether exposure to three different delivery modes of virtual nature could reduce negative affect (including boredom) and/or increase positive affect. Adult volunteer participants (n = 96) took part in a boredom induction task (to simulate the emotional state of many people in health/care settings) before being randomly assigned to view/interact with a virtual underwater coral reef in one of three experimental conditions: (a) 2D video viewed on a high-definition TV screen; (b) 360⁰ video VR (360-VR) viewed via a head mounted display (HMD); or (c) interactive computer-generated VR (CG-VR), also viewed via a HMD and interacted with using a hand-held controller. Visual and auditory content was closely matched across conditions with help from the BBC's Blue Planet II series team. Supporting predictions, virtual exposure to a coral reef reduced boredom and negative affect and increased positive affect and nature connectedness. Although reductions in boredom and negative affect were similar across all three conditions, CG-VR was associated with significantly greater improvements in positive affect than TV, which were mediated by greater experienced presence and increases in nature connectedness. Results improve our understanding of the importance of virtual nature delivery mode and will inform studies in real care settings.

Activities on acute mental health inpatient wards: A narrative synthesis of the service users' perspective

WHAT IS KNOWN ON THE SUBJECT?: Boredom is a big issue on inpatient mental health wards that is linked to poor patient satisfaction, feelings of frustration and increased incidents of self-harm and aggression. This is even more so for people detained under the Mental Health Act. Where wards have a good range of activities, for example art, music, computer games, gardening and exercise, service users felt less bored and had improved well-being. Over many years, studies have reported a lack of activities, especially during evenings and weekends. It has also been found that little is known about what activities service users want, or how activities might be meaningful for them. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review found that very few studies have asked service users about what activities would be useful and why. By seeing what makes activities desirable and accessible, we can understand how to improve the experiences of service users on wards. Overall, these data help to understand what impact activities (or lack of activities) have on service users and staff experiences on these wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Through identifying the activities most appreciated and engaged with by service users and by asking service users what activities they would like available, we can inform best practice guidance for the commissioning and provision of inpatient mental health care. This will enable service provider organizations to target their effort and resources on supporting good practice and to redirect resources from less useful activities. ABSTRACT: Background Concern about the lack of activities on mental health inpatient wards is long-standing with reports consistently finding that service users receive insufficient access to a range of activities and report high levels of boredom. There is recognition that little is known about what service users want when admitted to inpatient wards. Aim This review seeks to understand service users' experiences and views in relation to the provision and availability of activities, and to explore the perceived benefits and barriers to service users. Methods We searched multiple databases (Scopus, MEDLINE, CINAHL, PsycINFO and Embase) for studies that evaluated activities on acute adult inpatient mental health wards. We identified 12 papers across a range of methodological designs from which the narrative synthesis has been analysed. Results Findings show that the provision of activities is unsatisfactory for many service users, which in turn is related to increased boredom that has a negative impact on service users' well-being. We explore the benefits and barriers to engagement, providing an insight into the aspects that make an activity important. Conclusion There are few studies exploring the needs of service users regarding activity provision; therefore, there is limited knowledge about what is meaningful for individuals.

Hard to Bear

Abstract. Establishing a causal relationship between state boredom and risk taking is contributory to understand the nature of boredom and its influences. This research examines how and why state boredom influences financial risk taking. Across multiple inductions of state boredom, we found that state boredom increased participants’ preference for engaging in financial risk-taking behavior (Studies 1, 2, and 3) and actual financial risk-taking behavior (Studies 2 and 4). An internal meta-analysis verified the robustness of this effect. We also assessed four potential mediators and found motivation to seek stimulation as the best explicable mediator (Studies 3 and 4). Overall, the current research signified the role of state boredom in predicting financial risk taking as a function of motivation to seek stimulation.

New directions for improving the prediction, prevention, and treatment of suicidal thoughts and behaviors among hospital patients

Each year in the United States, suicidal thoughts and behaviors lead to >15 million visits to emergency departments and stays in psychiatric inpatient units. We describe three key areas where advances are needed: (1) more accurate detection of patients at risk for suicide in hospital settings, (2) better use of time and resources with patients while in the hospital, and (3) identifying patients who are at the highest risk for suicide when their risk is at its highest. In this introduction to the special issue, we provide describe how the papers in this issue make needed advances regarding these three topics and outline directions for future suicide research in hospital settings.

Boredom in Borderline Personality Disorder: A Lost Criterion Reconsidered

Difficulty with boredom was eliminated from the formal diagnostic criteria for borderline personality disorder (BPD) in 1994 based on significantly limited, unpublished data. However, it is apparent in clinical practice that boredom remains relevant to BPD. This review synthesizes empirical research, with consideration of theoretical accounts, to critically examine the relevance of boredom to BPD. We first briefly review issues in defining and measuring boredom and offer an expanded conceptualization for BPD, which includes the notion of boredom reactivity, before turning to boredom's differentiation from and overlap with feelings of emptiness, with which it was paired prior to its removal from the DSM. We then discuss perspectives on boredom's significance in BPD, briefly touching on its relevance in other personality disorders. We propose a Boredom Cascade Model that articulates how boredom and boredom reactivity interact with identity disturbance and chronic emptiness to create escalating patterns of behavioral dysregulation and make recommendations for research and treatment.

Depressive symptoms are related to boredom proneness in patients receiving hospital care, regardless of alcohol status, lifestyle, or social support

We examined the relationship between boredom proneness and psychological distress in patients receiving hospital care due either to excessive alcohol consumption or to gastrointestinal diseases. Sociodemographic data were collected together with boredom proneness subscales (internal/external lack of stimulation), psychological distress, physical activity, and social support. Boredom proneness due to a lack of external stimulation seemed to constitute a prominent personality trait in patients with alcohol consumption. But depressive symptoms were related only to boredom proneness due to a lack of internal stimulation in all patients, regardless of alcohol status, lifestyle, or social support. Potential implications for practice and future research are discussed.

Activation therapy for the treatment of inpatients with depression - protocol for a randomised control trial compared to treatment as usual

BACKGROUND

Inpatients with depression have a poor long term outcome with high rates of suicide, high levels of morbidity and frequent re-admission. Current treatment often relies on pharmacological intervention and focuses on observation to maintain safety. There is significant neurocognitive deficit which is linked to poor functional outcomes. As a consequence, there is a need for novel psychotherapeutic interventions that seek to address these concerns.

METHODS

We combined cognitive activation and behavioural activation to create activation therapy (AT) for the treatment of inpatient depression and conducted a small open label study which demonstrated acceptability and feasibility. We propose a randomised controlled trial which will compare treatment as usual (TAU) with TAU plus activation therapy for adult inpatients with a major depressive episode. The behavioural activation component involves therapist guided re-engagement with previously or potentially rewarding activities. The cognitive activation aspect utilises computer based exercises which have been shown to improve cognitive function.

DISCUSSION

The proposed randomised controlled trial will examine whether or not the addition of this therapy to TAU will result in a reduced re-hospitalisation rate at 12 weeks post discharge. Subjective change in activation and objectively measured change in activity levels will be rated, and the extent of change to neurocognition will be assessed.

TRIAL REGISTRATION

Unique trial number: U1111-1190-9517. Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12617000024347p .

A Failure to Launch: Regulatory Modes and Boredom Proneness

Boredom is a ubiquitous human experience characterized as a state of wanting but failing to engage with the world. Individuals prone to the experience of boredom demonstrate lower levels of self-control which may be at the heart of their failures to engage in goal-directed, meaningful behaviors. Here we develop the hypothesis that distinct self-regulatory profiles, which in turn differentially influence modes of goal pursuit, are at the heart of boredom proneness. Two specific regulatory modes are addressed: Locomotion, the desire to 'just do it,' an action oriented mode of goal-pursuit, and Assessment, the desire to 'do the right thing,' an evaluative orientation toward goal pursuit. We present data from a series of seven large samples of undergraduates showing that boredom proneness is negatively correlated with Locomotion, as though getting on with things acts as a prophylactic against boredom. This 'failure to launch' that we suggest is prevalent in the highly boredom prone individual, could be due to an inability to appropriately discriminate value (i.e., everything is tarred with the same gray brush), an unwillingness to put in the required effort to engage, or simply a failure to get started. In contrast, boredom proneness was consistently positively correlated with the Assessment mode of self-regulation. We suggest that this association reflects a kind of rumination that hampers satisfying goal pursuit.

Boredom proneness and its correlation with Internet addiction and Internet activities in adolescents with attention-deficit/hyperactivity disorder

This study examined the associations of boredom proneness with Internet addiction and activities as well as the moderators for such associations in adolescents with attention-deficit/hyperactivity disorder (ADHD). In total, 300 adolescents with ADHD participated in this study. Their Internet addiction, the scores for lack of external and internal stimulation on the Boredom Proneness Scale-short form (BPS-SF), ADHD, parental characteristics, and the types of Internet activities were examined. The associations of boredom proneness with Internet addiction and Internet activities and the moderators of the associations were examined using logistic regression analyses. Higher scores for lack of external stimulation on the BPS-SF were significantly associated with a higher risk of Internet addiction. Maternal occupational socioeconomic status moderated the association of lack of external stimulation with Internet addiction. Higher scores for lack of external stimulation were significantly associated with a high tendency to engage in online gaming, whereas higher scores for lack of internal stimulation were significantly associated with a low tendency to engage in online studies. Lack of external stimulation on the BPS-SF should be considered a target in prevention and intervention programs for Internet addiction among adolescents with ADHD.

Exploring the relationship between activities and emotional experience using a diary in a mental health inpatient setting

Mental health inpatient milieus have repeatedly been found to be associated with passivity, social disengagement, and low levels of interaction with staff. However, little is known about patients' experiences related to different ward activities. In the present study, we aimed to study the reports of activities and associated experiences of patients admitted to acute psychiatric inpatient wards. Disengaged, inactive, and solitary activities were hypothesized to be associated with less reward and more distress than their counterparts. We also aimed to investigate if such activities predicted distress, and if they were associated with clinical severity. Participants (n = 102) recorded their activities along with concurrent ratings of reward and distress in a structured 1-day diary, and nurses provided clinical severity ratings. On average, 3.74 of the 11 hours assessed (34%) were spent doing nothing, only 0.88 hours (8%) were spent with staff, and most of the time was spent in solitude. Doing nothing, being alone, and passivity were associated with the greatest levels of distress and lowest levels of reward, whereas informal socializing demonstrated the opposite pattern. Distress was not predicted by activity or reward when adjusting for baseline distress. Clinical severity was not associated with the amount of time spent alone or the experience of reward during activity. In conclusion, the risk for passivity and social disengagement during admission prevails. This activity pattern could have detrimental emotional consequences and warrants action, but more studies are needed to determine if activity actually precedes emotional experience.

Relieving in-patient boredom in general hospitals: the evidence for intervention and practical ideas

Boredom is highly prevalent among general hospital in-patients. Self-help strategies suit some patients, but for others hospitals need to stimulate opportunities for them to experience meaningful relationships and roles and a sense of control. In-patients' well-being and levels of boredom may be affected by no-smoking policies, hospital design, access to natural light, nature scenes and indoor or outdoor gardens. Alleviating boredom in elderly patients with reduced cognitive function may be particularly challenging. Healthcare professionals may face the wider challenge of fully engaging with patients' psychosocial needs, given the biomedical model that privileges the ‘traditional medical history’ over the more holistic communication model. Engaging with patients' psychosocial needs is consistent with managing their experience of 'sickness' rather than focusing on the narrower concept of ‘disease’.

The Moral Dimensions of Boredom: A Call for Research

Despite the impressive progress that has been made on both the empirical and conceptual fronts of boredom research, there is one facet of boredom that has received remarkably little attention. This is boredom's relationship to morality. The aim of this article is to explore the moral dimensions of boredom and to argue that boredom is a morally relevant personality trait. The presence of trait boredom hinders our capacity to flourish and in doing so hurts our prospects for a moral life.

Psychometric Analysis of the Multidimensional State Boredom Scale and Its Condensed Versions

The Multidimensional State Boredom Scale (MSBS) is a promising new self-report measure of state boredom. Two condensed versions of the scale have also been introduced. This study helped explore the psychometric qualities of these scales, using a large sample of Australian adults ( N = 1,716), as well as two smaller samples ( N = 199 and N = 422). Data analyses indicated strong convergent validity and very high internal consistency for the scales. Test–retest reliability over a 6- to 8-day period was moderately high. Confirmatory factor analyses of the MSBS authors’ suggested factor structure indicated good fit for this model. However, some of the data analyses raise questions as to whether the scale includes meaningful subfactors. Overall, the MSBS (and Short Form) is recommended for researchers who wish to assess state boredom.

Boredom in the Workplace: Reasons, Impact, and Solutions

Boredom in the workplace is not uncommon, and has been discussed widely in the academic literature in relation to the associated costs to individuals and organizations. Boredom can give rise to errors, adverse patient events, and decreased productivity-costly and unnecessary outcomes for consumers, employees, and organizations alike. As a function of boredom, individuals may feel over-worked or under-employed, and become distracted, stressed, or disillusioned. Staff who are bored also are less likely to engage with or focus on their work. In this article, we consider the nature of boredom and also the reasons why employees, including mental health nurses, become bored in the workplace. We also discuss the role that can be taken by employees and employers to recognise and address the problem of boredom and we consider how best to develop sustainable workplaces that are characterised by engaged employees who provide the best possible service in healthcare settings.

Self-Report Measures of Boredom: An Updated Review of the Literature

A detailed review of the psychometric measures of boredom was published approximately 12 years ago (Vodanovich, 2003). Since that time, numerous studies have been conducted on existing scales, and new measures of boredom have been developed. Given these assessment advancements, an updated review of self-report boredom scales is warranted. The primary focus of the current review is research published since 2003, and it includes a total of 16 boredom scales. The measures reviewed consist of two trait assessments (Boredom Proneness Scale, Boredom Susceptibility subscale of the Sensation Seeking Scale), five context-specific trait boredom scales (Boredom Coping Scale, Leisure Boredom Scale, Free Time Boredom Scale, Sexual Boredom Scale, Relational Boredom Scale), three assessments of state boredom (Multidimensional State Boredom Scale, State Boredom Measure, Boredom Experience Scale), and six context-specific state boredom measures-Lee's Job Boredom Scale, Dutch Boredom Scale, Boredom Coping Scale (Academic), the Boredom subscale of the Achievement Emotions Questionnaire, Academic Boredom Scale, Precursors to Boredom Scale. In addition to providing a review of these measures, a brief critique of each scale is included, as well as suggestions for needed research focus.

Boredom proneness predicts quality of life in outpatients diagnosed with schizophrenia-spectrum disorders

BACKGROUND

There is increasing recognition of the clinical significance of boredom associated with functional impairments in schizophrenia. Previous work has highlighted the importance of motivational deficits more broadly, although no study has yet explored the unique effects of boredom on community outcomes.

AIMS

This study aims to measure boredom proneness among outpatients diagnosed with schizophrenia to determine whether it is elevated in this population and to determine its relation to quality-of-life outcomes.

METHODS

A self-report measure of boredom proneness along with standard measures of symptoms and functional status was administered to a community-dwelling sample of schizophrenia outpatients.

RESULTS

Boredom proneness was found to be elevated in this population and was associated with reduced quality of life, specifically with leisure activity dissatisfaction and reduced sense of financial well-being. Negative symptoms were determined to be associated with reduced work and school functioning.

CONCLUSION

This pattern of unique effects on quality of life highlights the clinical relevance of identifying a subjective state of boredom and has theoretical importance in distinguishing boredom proneness specifically from more general avolitional and amotivational conditions that have tended to be the focus of clinical observation and previous research.

Treatment and Control: A Qualitative Study of Older Mentally Ill Offenders' Perceptions on Their Detention and Care Trajectory

The life of older mentally ill offenders (OMIOs) is often characterized by successive periods of detention in correctional facilities, admissions to psychiatric services, and unsuccessful attempts to live independently. Through in-depth interviews, eight personal stories from OMIOs under supervision of the commission of social defence in Ghent (Belgium) were analyzed in the phenomenological research tradition. The results of the study reveal that OMIOs had more positive and less negative experiences in prison settings when compared with other institutional care settings. Independent living, unsurprisingly, is favored the most. This may be due to the fact that the latter option fosters personal competence, feelings of being useful, personal choices, and contact with the "outside" world. Even in later lifetime, a combined approach of risk assessment with improvement of well-being remains valuable to stimulate offender rehabilitation. Therefore, more research into concepts that could be used to support OMIOs needs further consideration.

The Unengaged Mind: Defining Boredom in Terms of Attention

Our central goal is to provide a definition of boredom in terms of the underlying mental processes that occur during an instance of boredom. Through the synthesis of psychodynamic, existential, arousal, and cognitive theories of boredom, we argue that boredom is universally conceptualized as "the aversive experience of wanting, but being unable, to engage in satisfying activity." We propose to map this conceptualization onto underlying mental processes. Specifically, we propose that boredom be defined in terms of attention. That is, boredom is the aversive state that occurs when we (a) are not able to successfully engage attention with internal (e.g., thoughts or feelings) or external (e.g., environmental stimuli) information required for participating in satisfying activity, (b) are focused on the fact that we are not able to engage attention and participate in satisfying activity, and (c) attribute the cause of our aversive state to the environment. We believe that our definition of boredom fully accounts for the phenomenal experience of boredom, brings existing theories of boredom into dialogue with one another, and suggests specific directions for future research on boredom and attention.

Mental health service users' experiences of mental health care: an integrative literature review

A number of studies have highlighted issues around the relationship between service users and providers. The recovery model is predominant in mental health as is the recognition of the importance of person-centred practice. The authors completed an in-depth search of the literature to answer the question: What are service users' experiences of the mental health service? Three key themes emerged: acknowledging a mental health problem and seeking help; building relationships through participation in care; and working towards continuity of care. The review adds to the current body of knowledge by providing greater detail into the importance of relationships between service users and providers and how these may impact on the delivery of care in the mental health service. The overarching theme that emerged was the importance of the relationship between the service user and provider as a basis for interaction and support. This review has specific implications for mental health nursing. Despite the recognition made in policy documents for change, issues with stigma, poor attitudes and communication persist. There is a need for a fundamental shift in the provider-service user relationship to facilitate true service-user engagement in their care. The aim of this integrative literature review was to identify mental health service users' experiences of services. The rationale for this review was based on the growing emphasis and requirements for health services to deliver care and support, which recognizes the preferences of individuals. Contemporary models of mental health care strive to promote inclusion and empowerment. This review seeks to add to our current understanding of how service users experience care and support in order to determine to what extent the principles of contemporary models of mental health care are embedded in practice. A robust search of Web of Science, the Cochrane Database, Science Direct, EBSCO host (Academic Search Complete, MEDLINE, CINAHL Plus Full-Text), PsycINFO, PsycARTICLES, Social Sciences Full Text and the United Kingdom and Ireland Reference Centre for data published between 1 January 2008 and 31 December 2012 was completed. The initial search retrieved 272 609 papers. The authors used a staged approach and the application of predetermined inclusion/exclusion criteria, thus the numbers of papers for inclusion were reduced to 34. Data extraction, quality assessment and thematic analysis were completed for the included studies. Satisfaction with the mental health service was moderately good. However, accessing services could be difficult because of a lack of knowledge and the stigma surrounding mental health. Large surveys document moderate satisfaction ratings; however, feelings of fear regarding how services function and the lack of treatment choice remain. The main finding from this review is while people may express satisfaction with mental health services, there are still issues around three main themes: acknowledging a mental health problem and seeking help; building relationship through participation and care; and working towards continuity of care. Elements of the recovery model appear to be lacking in relation to user involvement, empowerment and decision making. There is a need for a fundamental shift in the context of the provider-service user relationship to fully facilitate service users' engagement in their care.