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
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
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To assess the levels of service user satisfaction in forensic in-patient settings in one mental health trust.
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To examine the perceived therapeutic relationship of the service users with their keyworkers.
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To examine the perceived social climate of the wards.
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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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