Associations between ward climate and patient characteristics in a secure forensic mental health service

Abstract

Ward climate is associated with patient satisfaction and, potentially, with improved outcomes but increased understanding of its relationship with individual patient characteristics is required. We investigated relationships between patient (N = 63) gender, perceived risk, risk behaviour, therapeutic engagement (session attendance), psychopathology and ward climate in a forensic psychiatric hospital. Lower security levels were significantly associated with better patient cohesion (PC), experienced safety (ES) and therapeutic hold (TH). Female gender predicted PC and ES. Higher perceived risk was associated with lower PC after controlling for security level and gender. Diagnosis of personality disorder or psychosis was associated with higher ES. Lower levels of engagement predicted greater TH. The relationship between patient characteristics and ward climate in forensic settings is complex. Prospective studies are needed to further establish determinants of ward climate, particularly those aspects of patient risk that are associated with poorer PC.

Ward Climate Within a High Secure Forensic Psychiatric Hospital: Perceptions of Patients and Nursing Staff and the Role of Patient Characteristics

“…In contrast to Dickens et al (2014) there is also research showing that patient characteristics have a small or no impact on ward climate (Moos, 1997;Pedersen & Karterud, 2007). Pedersen and Karterud (2007) found no substantial associations between patient characteristics (gender, age, level of education, self reported symptom distress, interpersonal problems, diagnosis) and individual ratings of treatment milieu.…”

“…For instance, Howells et al (2009) found that patients in a high secure hospital service in the United Kingdom (UK) evaluated cohesion among patients more favorably than staff members. Another study found that patients in open, low and medium secure wards of a psychiatric hospital in the UK evaluated the ward climate as safer than staff members (Dickens et al, 2014). In both studies, staff members evaluated the therapeutic hold (how much the environment is supportive of therapy and therapeutic change) more favorably compared to patients.…”

“…Possible explanations given in previous research for the divergent perceptions between nursing staff and patients are, the different roles and functions that staff and patients have within a forensic institution (Caplan,1993;Goffman, 1961;Rossberg & Friis, 2004), and the restrictions to the liberty and personal freedom of incarcerated patients (Langdon, Cosgrave & Tranah, 2004). Patients' restricted liberty could also be a potential explanation for the finding that the perception of climate differs as a function of the level of security (Dickens et al, 2014;Long et al, 2011;Milsom et al, 2014).…”

“…Recent research by Dickens et al (2014) (HCR-20;Webster, Douglas, Eaves, & Hart, 1997) was associated with lower perceived patient cohesion, a diagnosis of personality disorder or psychosis according to the ICD-10 (WHO, 2010) was related to higher experienced safety, and higher levels of engagement (i.e., the number of programmed therapeutic sessions attended over a two-week period) was associated with greater therapeutic hold.…”

“…However, creating an optimal climate within a high security forensic setting can be very challenging due to the complex patient population, involuntary admission within a closed setting and the balance between security needs and treatment goals (Burrows, 1991;Campling, Davies, & Farquharson, 2004;Howells, Krishnan, & Daffern, 2007). Moreover, patients and staff members working within forensic psychiatric settings seem to evaluate ward climate differently (Caplan, 1993;Day, Casey, Vess, & Huisy, 2011;Dickens, Suesse, Snyman, & Picchioni, 2014;Howells et al, 2009;Livingston et al, 2012;Long et al, 2011;Moos, 1975;Rossberg & Friis, 2004;Schalast, Redies, Collins, Stacey, & Howell, 2008;Morrison, Burnard, & Phillips, 1997). For instance, Howells et al (2009) found that patients in a high secure hospital service in the United Kingdom (UK) evaluated cohesion among patients more favorably than staff members.…”