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Open Access Highly Accessed Research article

Factors affecting staff morale on inpatient mental health wards in England: a qualitative investigation

Jonathan Totman1, Gillian Lewando Hundt2, Elizabeth Wearn1, Moli Paul3 and Sonia Johnson14*

Author Affiliations

1 Research Department of Mental Health Sciences, University College London, Gower Street, London, WC1E 6BT, UK

2 School of Health and Social Studies, Institute of Health, University of Warwick, Coventry, CV4 7AL, UK

3 The University of Warwick, Warwick Medical School, Gibbet Hill Campus, Coventry, CV4 7AL, UK

4 Camden and Islington NHS Foundation Trust, London, UK

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BMC Psychiatry 2011, 11:68  doi:10.1186/1471-244X-11-68

Published: 21 April 2011



Good morale among staff on inpatient psychiatric wards is an important requirement for the maintenance of strong therapeutic alliances and positive patient experiences, and for the successful implementation of initiatives to improve care. More understanding is needed of mechanisms underlying good and poor morale.


We conducted individual and group interviews with staff of a full range of disciplines and levels of seniority on seven NHS in-patient wards of varying types in England.


Inpatient staff feel sustained in their potentially stressful roles by mutual loyalty and trust within cohesive ward teams. Clear roles, supportive ward managers and well designed organisational procedures and structures maintain good morale. Perceived threats to good morale include staffing levels that are insufficient for staff to feel safe and able to spend time with patients, the high risk of violence, and lack of voice in the wider organisation.


Increasing employee voice, designing jobs so as to maximise autonomy within clear and well-structured operational protocols, promoting greater staff-patient contact and improving responses to violence may contribute more to inpatient staff morale than formal support mechanisms.