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Patients who have intellectual disability and mental illness will occasionally need inpatient treatment. However, research is sparse on psychosocial factors influencing psychiatric units for patients with intellectual disabilities. The aim of this study is to examine whether adults with intellectual disabilities can reliably rate the Ward Atmosphere Scale – Real Ward (WAS‐R).

A total of 17 patients with mild and moderate intellectual disability and 21 staff members were asked to complete the WAS‐R. The authors used six subscales (involvement, support, practical orientation, order and organisation, angry and aggressive behaviour, and staff control) that have proved to be of major importance for patient satisfaction and treatment outcome to measure the patients' and the staff members' perceptions of the treatment milieu. To examine the internal consistency Cronbach's alpha was calculated for the patient and staff scores, respectively.

A total of 16 patients completed the form. Patients with mild intellectual disabilities were able to answer the WAS with some help, whereas patients with moderate intellectual disabilities had major difficulties with understanding more than half of the WAS items. These difficulties were also reflected in the internal consistency scores. Cronbach's alpha was satisfactory (≥0.50) for five subscales for patients with mild intellectual disabilities, but only satisfactory for two of the six subscales for patients with moderate intellectual disabilities.

A replication study should use a shorter version of the WAS‐R, and family or caregivers should answer the WAS‐R additionally to the patients.

This study may encourage more research on treatment milieu for patients with intellectual disability and mental illness.

The purpose of this research was two‐fold: first, to compare staff and patient perceptions of two new wards in a medium‐secure unit with perceptions obtained previously for a unit that has since closed, and second, to compare staff and patient perceptions of the new ward with their ideal ward environment. The results obtained from patients indicated that there were differences between perceptions of the new treatment unit and the former treatment unit. The results obtained from patients also indicated that there was a difference between perceptions of the new treatment unit and the ideal ward environment. Results obtained from staff could not be analysed because of a low response rate.

This research attempts to explore in‐patient perspectives on the long‐stay, medium‐secure hospital wards in which they are based. Semi‐structured interviews focused on the care provided by the hospital in comparison with the high‐secure hospitals from which the participants had been transferred. Questions focused on the participants' perceptions of recovery and the scope for it at both sites.The data suggests that participants identify increased scope for recovery at the long‐stay, medium‐secure facility, and that this is promoted by increased flexibility due to less emphasis on security. Important factors discussed by participants were increased access to a range of activities, graded access into the community, the different atmosphere in the hospital sites and the differences in potential for developing trusting relationships with staff and fellow in‐patients.

Patients detained in high-security psychiatric hospitals are particularly vulnerable to excessive restrictions and exploitation. In the UK, the care quality commission (CQC) monitors and regulates forensic healthcare provision. The purpose of this study is to identify key concerns highlighted in CQC inspection reports of the three high-secure hospitals in England between 2010 and 2018.

In this qualitative study, 49 CQC inspection reports from three high-secure hospitals were subjected to thematic analysis.

Five central themes emerged: staffing and management; restrictive practice; physical environment and ward atmosphere; patients’ needs and involvement in their care; and legal and statutory matters. There was some variation in the overall quality of care between the hospitals. Positive staff–patient interactions and good practice in assessing and delivering care were consistently observed. However, enduring staff shortages within each hospital were experienced negatively and sometimes co-occurred with concerns over restrictive practices, poor care-plan procedure and inadequate legal documentation. Over time, Rampton and Broadmoor Hospitals appeared to worsen with regard to staffing levels, staff morale and management involvement. While services progressed over time in providing patients with access to advocacy and information concerning their rights, in some recent inspections it remained unclear whether patients were adequately involved in the care-plan process.

These findings provide preliminary indicators for areas requiring further attention from policymakers, clinicians and advocates.

This study appears to be the first systematic analysis of key concerns expressed in CQC reports of English high-security hospitals.

The Millfields unit is one of three medium secure hospital services on the Offender Personality Disorder (OPD) pathway, for the assessment and treatment of high-risk offenders who are likely to meet criteria for this diagnosis. This study has designed an audit to examine influencers of patient engagement within Millfields, whose treatment approach is that of an adapted therapeutic community (TC). The purpose of this study was to explore themes raised by patients in relation to engagement, drivers for and barriers to engagement and to make recommendations for improvement.

The first author engaged in ward and group observations, a review of each patient’s medical records, unstructured discussions with staff and semi-structured interviews with each patient exploring their experiences of therapy, relationships with staff, understanding of and engagement with the treatment model, attitudes towards peers and aspirations for the future. Themes were generated from the transcription of interviews and subsequent mind mapping.

In total, 12 of the 13 patients engaged in the semi-structured interviews. Six main themes were identified as being important influencers of engagement: the ward atmosphere, authenticity of engagement, perception of staff investment in the treatment, preferential treatment of senior residents, responses to boundary crosses and violations and the level of understanding a patient had of his treatment.

Research into engagement with psychosocial therapies in patients who have personality disorders has recently been published by Tetley et al. (2012) and Jinks et al. (2012). This study specifically focusses on TC engagement and male offenders with personality disorders.

This service evaluation study aimed to demonstrate the impact of implementing ward‐based multidisciplinary therapy input on an acute psychiatric ward in a London hospital for a six‐month period. The results indicated a high level of patient engagement with the project and referrals facilitated for patients following discharge. A reduction of incidents on the ward was reported over the project period compared to the previous year and there was less use of containment measures by staff by the end of the project. Recommendations are made for service improvement.

In 2019, the world was hit by a life threatening severe acute respiratory syndrome causing a global pandemic; Coronavirus disease (COVID-19). In the UK, a nationwide “lockdown” of public isolation and reduced social contact followed. The experience of COVID-19 and the lockdown for forensic secure mental health patients is yet to be understood. This study aims to explore this phenomenon from the patients’ perspective.

A qualitative approach was taken. Semi-structured interviews were carried out with six patients from a low secure unit in the UK, between November 2020 and March 2021.

Interpretive phenomenological analysis generated three superordinate themes from the data, providing insight into patients’ experience: “treading water”; how they managed: “learning to swim”; and what was helpful during this time: “in the same boat”.

Further consideration should be given to creating a sense of safety in wards, along with ways to continue to address the power imbalance. Interestingly, social connection may be cultivated from within the hospital setting and would benefit from further research.

To the best of the authors’ knowledge, this is the first study to explore secure patients’ experience of COVID-19 from the patients’ perspective, within a population often neglected within recovery research.

The social climate of psychiatric institutions correlates with multiple outcomes related to staff and patients. Research into social climate in Learning Disability services is limited. Staff and patients in Learning Disability services have documented both positive and negative experiences. No research has directly compared the social climate of Learning Disability and non-Learning Disability psychiatric services. The purpose of this paper is to understand how these compare. The study will also compare staff and patient views of social climate and the impact of security on social climate in Learning Disability services.

A total of 64 patients and 73 staff, from Learning Disability and non-Learning Disability psychiatric hospitals completed the Essen Climate Evaluation Schema (EssenCES) measure of social climate.

Patients in Learning Disability and non-Learning Disability services did not differ in their perceptions of social climate. Staff in non-Learning Disability services had a more positive perception of social climate than staff in Learning Disability services. Patients and staff did not differ in their views on climate. Security was negatively related to patients’ Experienced Safety.

The findings suggest that staff perceive that the deficits associated with Learning Disabilities may limit patients’ therapeutic experience and relationships with their peers. Despite this, patients with Learning Disabilities feel supported by their peers, have positive views of the treatment process and feel as safe as non-Learning Disabled psychiatric patients.

Social climate (ward atmosphere) affects numerous treatment outcomes. The most commonly used measure is the Essen Climate Evaluation Schema (EssenCES) (Schalast et al., 2008). Though studies have investigated the psychometric properties of EssenCES in intellectual disability populations, few have focused on the clinical utility, or accessibility of the measure. The purpose of this paper is to examine clinician's experiences of using this measure with this population.

Clinicians experienced in administering EssenCES with forensic intellectual disability patients completed an open-ended questionnaire, which sought qualitative data on their experiences of using EssenCES with this population. Data were analysed using thematic analysis.

A number of issues were raised regarding use of EssenCES with patients with intellectual disability. Four overarching themes arose: Understanding of Language, Commenting on Others, Understanding of Likert Scale, and Scale Positives and Adaptation. Clinicians felt certain items were not uniformly understood by all patients, particularly those that incorporated abstract concepts, double negatives, or complex language.

Results suggest forensic intellectual disability patients vary in their ability to understand EssenCES items. This resulted in significant further explanation by the administering clinician, a practice which raised concern regarding reliability. Results provide preliminary evidence to indicate EssenCES use requires further consideration in intellectual disability services, or adaptation for this client group.

The aim of the present study is to explore the psychometric properties of the EssenCES measure (patient report) of social climate in a secure service for people with intellectual disabilities.

Patients (37 men, 14 women, Mean age=33.24 years, SD=11.29, age range: 18‐71 years) residing in a secure intellectual disabilities service completed the EssenCES as part of routine clinical practice.

Reliability analysis revealed acceptable reliability for all three subscales (α=0.76‐0.88). In order to consider one aspect of the construct validity of this measure, a predicted group difference regarding the impact of security level on ratings of social climate was investigated. Analysis revealed that social climate ratings were more positive on low secure wards than medium secure wards as measured by the combined EssenCES subscales F(3, 31)=4.71, p=0.008; Λ=0.69; η²=0.31, and the Experienced Safety subscale, F(1, 33)=7.41, p=0.01.

Future research should consider the link between social climate and treatment outcome within forensic secure intellectual disability services.

Results provide preliminary evidence to suggest that the EssenCES subscales (patient report) are reliable in this previously unconsidered population. However the validity of the measure is still unclear and requires further investigation.