TULIPS: Talk, Understand Listen for In-Patient Settings

Key information

• Study duration: October 2018 to March 2024
• Chief Investigator: Prof Katherine Berry
• Part of the Complex Trauma & Resilience Research Unit (C-TRU) 
• Sponsored by the University of Manchester
• Funded by the National Institute of Health and Care Research (NIHR)
• Took place at Greater Manchester Mental Health NHS Foundation Trust (GMMH)

What was the study about?

When people are admitted to a mental health ward, it is usually because they are experiencing severe distress or crisis. Access to psychological therapies, such as cognitive behavioural therapy (CBT), is uncommon on these wards, despite national guidelines recommending that people with severe mental health difficulties should be offered therapy alongside other care.

Our team worked closely with people who have first-hand experience and expertise of inpatient care for mental health to understand the barriers to delivering and receiving therapy on wards and how to overcome them. We reviewed existing research, carried out interviews and workshops, and tested different ways of offering therapy.

From this work, the team created the TULIPS intervention, which aimed to increase patient access to talking therapies in a number of different ways depending on each person’s needs and preferences. To help deliver the intervention, a psychologist was based on the ward 2 ½ days per week and trained and supported other staff in psychological therapies.

The TULIPS intervention was tested on 34 mental health wards. Half of the wards were randomly selected to deliver the TULIPS intervention for seven months, whilst the other half continued providing care as usual without a psychologist. 

Researchers compared the two groups of wards to see whether the TULIPS intervention improved patient wellbeing, reduced serious incidents, and supported staff. Feedback was further gathered from both patients and staff on their experiences of the care they received during the TULIPS project. We also looked at how closely the TULIPS approach was delivered as planned.

What did the study find?

Wards using the TULIPS model saw a 19% drop in overall incidents of harm to self and others compared to usual care: although this reduction was not big enough for us to be confident it did not occur by chance, it represents around one fewer incident in every five. Whilst there were no significant changes in patient outcomes, staff on TULIPS wards with a psychologist also felt a stronger sense of personal achievement and were less emotionally exhausted by the end of the research.

32 staff and 31 patients were interviewed about their experiences of the TULIPS project. Through these interviews, we found that patients who experienced the TULIPS approach on their ward felt more listened to, understood, and supported. Ward staff reported that psychologists helped them respond with more care and compassion and gave them confidence in supporting their patients’ emotional needs. Overall, patients and staff agreed that it was important to have therapy available during admission, and patients wanted this type of support to continue after discharge.