Levels of service user satisfaction in secure settings – A survey of the association between perceived social climate, perceived therapeutic relationship and satisfaction with forensic services

https://doi.org/10.1016/j.ijnurstu.2011.05.011Get rights and content

Abstract

Background

The interests of users should lead service developments. However, it has been claimed that forensic mental health services have largely ignored examining users’ views on the nature and quality of the service offered to them. Perceived social climate and perceived therapeutic relationship are viewed as important indicators of treatment outcome; however previous findings about how these variables may be associated with satisfaction with forensic services are equivocal.

Objectives

This study aims to assess the levels of service user satisfaction in forensic in-patient settings in one mental health trust and explore how the perceived therapeutic relationship of the service users with their key-workers and the perceived social climate of the wards are associated with service user satisfaction.

Design

A cross-sectional survey design was chosen and an independent researcher facilitated the completion of three standardised assessments measuring service user satisfaction, therapeutic relationships and the social climate of the ward.

Method

Forty-four service users detained in secure settings completed the standardised assessments. The study was conducted in four medium secure and three low secure units in one NHS mental health trust. The data was analysed to examine the level of satisfaction with services and how both the therapeutic relationship and the ward environment were related to levels of satisfaction.

Results

The majority of service users who responded were generally satisfied with services; “rehabilitation” and “perceived safety” were viewed most positively. Service users’ perceptions about the social climate of the ward were found to have a significant relationship with service users’ satisfaction with forensic services. However, the variables with the strongest association with satisfaction with forensic services are service users’ perceptions about the nature of therapeutic relations with staff.

Conclusions

This study indicates that service users’ satisfaction with forensic services is strongly associated with their experiences of the therapeutic relationship with their key-workers and the social climate of the ward. The findings emphasize the importance of forming and maintaining effective therapeutic relations and reinforce the need to maintain a therapeutic environment free of aggressive tension and threats of violence. The results also highlight the potential for service users to be dissatisfied with their financial situation following admission.

Section snippets

Background

The UK Department of Health (2002) guidance states that the interests of users should lead service developments and treatment guided by their aspirations and experiences. However, it has been claimed that forensic mental health services have largely ignored examining users’ views on the nature and quality of the service offered to them (Morrison et al., 1996). NIMHE (2004) in their review of forensic mental health services noted a lack of a service user perspective and involvement in service

Aims and objectives

  • To assess the levels of service user satisfaction in forensic in-patient settings in one mental health trust.

  • To examine the perceived therapeutic relationship of the service users with their keyworkers.

  • To examine the perceived social climate of the wards.

  • To examine the association between the perceived therapeutic relationship and social climate of the ward with service user satisfaction with services.

Design

A cross-sectional survey design was chosen allowing the views of all service users to be assessed. A standardised approach was used in the study to ensure only questions of interest to the project were asked, recorded, codified, and analysed (De Vaus, 2000).

Recruitment of participants

Every service user receiving in-patient care in the forensic directorate of the mental health trust was invited to take part, with the only exclusion criterion being any service user who the clinical team viewed as not being able to complete the assessments. All the service users were approached and informed about the project through the use of posters on the ward, by verbal information given at the ward meeting and through their key-worker. Each service user was also given written information

Ethical considerations

Ethical approval was granted by the University's Research Ethics Committee. The assessments were anonymised to ensure that individual service users were not able to be identified from the data. In order to minimise the risk of participants feeling coerced to take part; the information sheet and consent form clearly stated that participation was entirely voluntary, would have no direct impact upon treatment being received and that participants had the right to withdraw from the project at any

Data collection

Demographic Information was requested regarding age, gender, ethnicity and length of inpatient stay. In addition to the demographics, three assessment measures were completed. Table 1 details each measure and the associated subscales.

Data analysis

For the FSS, the descriptive scores of the forensic domains, as well as total score were examined. Descriptive analysis was undertaken for the HAS and EssenCES domain scores to assess the perceived therapeutic relationship and ward climate. Pearson correlations were conducted to explore the correlations between the individual domains on the EssenCES and HAS with the FSS domains and the total FSS score.

Results

Of the 110 service users receiving inpatient treatment 45 consented to participate in the study (a response rate of 40.9%). Service users who refused to take part were not required to give a reason for refusal. One service user defaced the assessment paperwork, so the remaining 44 sets of data were analysed.

Discussion

The results from this study demonstrate that service users were satisfied with most areas of forensic services and that, overall, 55% of the participants noted a level of satisfaction with the service provided. However, a number of participants also registered a level of dissatisfaction with services. Levels of satisfaction in this sample differ greatly from previously published studies that identify much higher rates of satisfaction with forensic services (Baker, 2003, Stallard, 1996). These

Conclusion

The majority of respondents in this survey were generally satisfied with their forensic mental health inpatient treatment. This study indicates that service users’ satisfaction with forensic services is related to their experiences of the therapeutic relationship with their key-workers and the social climate of the ward. Favourable views of the therapeutic relationship (measured using the HAS and EssenCES “therapeutic hold” domain) have a highly positive association with satisfaction in most

Acknowledgements

We extend our thanks to all the service users that were involved in this study, the clinical staff that were most helpful in facilitating access to the study participants and Cathy Bernal for proof reading the article.

Conflict of interest: None declared.

Funding: Oxleas NHS Foundation NHS Trust. The funders had no part in collecting, analyzing or interpreting or influencing the writing up of the data.

Ethical approval: Canterbury Christ Church University Faculty Ethics Committee (reference

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