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The purpose of this paper is to adapt a social climate measure for use within a forensic intellectual and developmental disabilities (IDD) service and examine perceptions of social climate and the links with patient aggression across three levels of security.

Four staff participated in a focus group to discuss how the Essen Climate Evaluation Schema (EssenCES) could be adapted for IDD patients. Subsequently, a pilot study with three patients highlighted some difficulties in administering the adapted measure. Alterations in the administration of the measure were implemented with a further ten patients residing across three levels of security. The EssenCES was adapted to include more visual prompts to assist in the patients’ completion of the measure. The frequency of aggressive incidents in each of the three settings was also collated.

Statistical analysis revealed a non-significant trend where positive social climate ratings increased as the security level decreased. There was a significant difference in the frequency of aggressive incidents across the three levels of security; however, there were no significant relationships found between the questionnaire ratings and the frequency of incidents.

The results lacked statistical power due to the low number of participants. Further studies with adapted social climate measures need to be conducted to assess the implications of social climate on individuals with IDD in secure forensic services.

The study adapted and piloted a social climate measure for individuals in a forensic IDD service.

The purpose of this paper is to explore how raters combine constituent components of Historical Clinical Risk-20 (HCR-20) risk assessment, and how relevant they rate the tool to different diagnostic and demographic groups.

A cross-sectional survey design of n=45 mental health clinicians (psychiatrists, psychologists, and others) working in a secure hospital responded to an online survey about their risk assessment practice.

HCR-20 Historical and Clinical subscales were rated the most relevant to violence prediction but four of the five items rated most relevant were Historical items. A recent history of violence was rated more important for risk formulation than Historical and Risk management items, but not more important than Clinical items. While almost all respondents believed predictive accuracy would differ by gender, the tool was rated similarly in terms of its relevance for their client group by people working with men and women, respectively.

This was an exploratory survey and results should be verified using larger samples.

Clinicians judge recent violence and Clinical items most important in inpatient violence risk assessment but may overvalue historical factors. They believe that recent violent behaviour is important in risk formulation; however, while recent violence is an important predictor of future violence, the role it should play in SPJ schemes is poorly codified.

It is important that risk assessment is accurate in order to both protect the public and to protect patients from overly lengthy and restrictive detention.

Despite the vast number of studies examining the predictive validity of tools like HCR-20 very little research has examined the actual processes and decision-making behind formulation in clinical practice.

This paper aims to describe research which was undertaken exploring organisational climate within a prison setting and the potential directional affects of work and home. The purpose of the research was to develop a conceptual framework of the impact of climate on social and emotional functioning.

Using the competing values framework 149 prison staff completed a questionnaire designed to explore the interactional effects of boundary theory, organisational climate and well being.

It was found that all staff placed emphasis on the control quadrant of the organisational climate. In addition, the data revealed a moderately curvilinear relationship between length of service and climate engagement on each of the quadrants. These results parallel other research in relation to attitude change. The desire for higher integration was associated with an increased impact on work/home life and a desire for, and achievement of, segmentation does not directly impact on subjective well being. The research concluded that viewing integration and segmentation along a continuum in relation to the prison service role is too simplistic. Rather, these should be viewed in a more complex way and a model for this is proposed. The findings also indicate that employees with high identity consistency (integration) also had a more engaged experience of the prison climate whereas employees with lower identity consistency (segmentation) were less engaged.

There are several implications of the research. Firstly, further research is required to explore the potential impact of attempting to change a prison climate in terms of understanding why certain climate quadrants may be preferred by staff in different roles. The findings indicate that where certain quadrant preferences occur these may be functional to prison safety and alteration of these should be considered carefully. The research also indicated that current theories of boundary management may have some applicability but that within a prison setting these are complex and influenced by both internal organizational factors and those within the wider community. Further research into the concept of “dirty work” and the impact this may have on climate would be of benefit.

This is the first research to explore the role of organizational climate within a prison setting and to consider factors which are specific to a prison environment which may influence the organizational climate. This paper is of value to those who are interested in prison settings and how the environment can influence employee experiences of working in a prison and how identity consistence can influence experiences of work.

From 2012, all high-secure forensic mental health services in England began operating a policy of confining patients to their locked bedrooms overnight to increase service efficiency and reduce costs. The purpose of this paper is to assess the views of staff and patients concerning the policy and examine the specific impact of the policy on patients.

Measures of patients’ sleep hygiene, patients’ behaviour, ward atmosphere, engagement with therapy and adverse incidents were taken both before and after the night confinement (NC) policy was implemented. Both patients and staff also expressed their views of the impact of the NC policy.

Results provide converging evidence that the impact of the NC policy on patients is negligible. There were no consistent negative effects of confining patients overnight. Rather, patients and staff were broadly positive about the impact that the practice had on patients.

Confining patients to locked bedrooms overnight does not exert any consistent influence, positive or negative, on patients’ sleep hygiene, behaviour or engagement with therapy, and patients expressed a broadly positive view of the practice of NC. Thus, a NC policy may have a contribution to make to the provision an effective high-secure mental health service.

The study provides convincing evidence that secure inpatient mental health services that are considering the adoption of a NC policy may do so without fear of a negative impact on patients.

The purpose of this paper is to explore service users’ experience of community meetings (CMs) within a high secure setting.

A qualitative design was employed in which focus groups were used to capture service users’ experience of CMs. In all, 12 focus groups comprising a total of 27 participants were carried out using a semi-structured interview schedule. Data were analysed using thematic and saliency analysis, identifying themes which were pertinent to the research aims.

Positive experiences reported by service users included a safe space to explore ward issues and develop skills, with some viewing the meeting as a therapeutic forum in which to facilitate personal growth.

There were a wide range of patient presentations and views. Furthermore, only 20 per cent of the patient population were included within this study.

A number of recommendations have been identified that can have positive implications for patients (quality of life and recovery), staff (resolving conflicts and problem-solving) and the overall therapeutic milieu of the ward.

There are no reviews looking at CMs within the last decade. This paper brings the understanding up to date to allow the development of this potentially positive tool.

The purpose of this paper is to describe the architectural design considerations and effects of moving patients from an adapted Victorian medium secure unit to a purpose built facility.

Patients and staff views of the old and new unit environments were compared in terms of homeliness, architectural features, ward atmosphere (WAS) and patient satisfaction.

The new unit was rated as more homely. The change of environment did not increase risk behaviours and was associated with a reduction in symptomatology.

Limitations of the study include the small‐sample size and choice of measure of WAS. More research is needed into the constituents of “planned” environments where the physical environment is the primary intervention.

These include the need for close collaboration among architects, clinicians and patients in order to maximise the therapeutic benefit of the built environment.

This paper contributes to a small literature that “bridges” architectural, psychiatric and environmental domains.

Although long a feature of inpatient mental health ward routine, community meetings have not always attracted a clear sense of purpose and value. A common complaint from patients is that community meetings are useless and have no worthwhile purpose. It was thought that staff on acute wards would benefit from having a space to think about community meetings, and a work discussion group was provided over a duration of 18 months. It was hoped that this intervention would enable facilitators to think about these meetings and about their aims and benefits. This paper presents findings from the work discussion group: staff facilitators' experience of facilitating community meetings and patients' direct feedback to facilitators about their experience of these meetings. The conclusions made are that community meetings could provide a useful forum for patients and staff if they:• are of benefit to patients• provide a forum for development of the therapeutic alliance between patients and staff• contribute towards improvement of the ward milieu• provide a forum for staff to develop therapeutic skills• provide a forum for staff to develop working relationships with colleagues and different professionals in the team.

This preliminary investigation aims to examine the psychological impact of the COVID-19 pandemic on patients and staff within a high secure service.

To discern the connection between COVID-19-related distress and multiple factors, the study involved 31 patients and 34 staff who completed assessments evaluating coping strategies, resilience, emotional reactivity, ward atmosphere and work-related aspects.

Results demonstrated that around a third of staff (31.2%) experienced COVID-19-related distress levels that met the clinical cut-off for possible post-traumatic stress disorder. Emotional reactivity, staff shortages, secondary traumatic stress and coping strategies were all positively correlated with COVID-19-related-distress. Resilience was negatively associated with distress, thus acting as a potential mitigating factor. In comparison, the prevalence of distress among patients was low (3.2%).

The authors postulate that increased staff burdens during the pandemic may have led to long-term distress, while their efforts to maintain minimal service disruption potentially shielded patients from psychological impacts, possibly lead to staff “problem-focused coping burnout”. This highlights the need for in-depth research on the enduring impacts of pandemics, focusing on mechanisms that intensify or alleviate distress. Future studies should focus on identifying effective coping strategies for crisis situations, such as staff shortages, and strategies for post-crisis staff support.

The authors postulate that the added burdens on staff during the pandemic might have contributed to their distress. Nonetheless, staff might have inadvertently safeguarded patients from the pandemic’s psychological ramifications by providing a “service of little disruption”, potentially leading to “problem-focused coping burnout”. These findings underscore the imperative for further research capturing the enduring impacts of pandemics, particularly scrutinising factors that illuminate the mechanisms through which distress is either intensified or alleviated across different groups. An avenue worth exploring is identifying effective coping styles for pandemics.

The purpose of this paper is to evaluate an organizationally oriented, patient-focused care (PFC) model's effects on care quality and work climate.

The study has a before-after (PFC implementation) design. The sample included 1,474 patients and 458 healthcare providers in six participating wards before and after PFC implementation, plus five additional randomly chosen wards, which only featured in the post-assessment.

No pre-post differences were found regarding care perceptions or provider work climate evaluations. Statistically significant improvements were noted among provider care evaluations. Using aggregate-level ward data, multiple regression analyses showed that high adherence to PFC principles and a positive work climate contributed significantly to variance among care quality ratings.

Among healthcare providers, questions related to specific PFC aspects during evenings, nights and weekends had to be dropped owing to a low response rate.

An important requirement for both practice and research is to tailor PFC to various health and social care contexts.

The study is large-scale before-after PFC model review, where patient and provider data were collected using well-established measurements.