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.

Keywords:

• ward climate
• risk
• diagnosis
• gender
• security
• EssenCES

Notes

1. G-Power; based on correlations in Long, Anagnostakis, et al. (2011).

2. The assumption of equality of variances was not met for the patient-rated experienced safety scale: Levene’s test of homogeneity of variances (2,32) = 6.657, p = .004. Welch robust test of equality of means substituted.