Research suggests that positive vibes, bonding activities, and getting on well with each other help reduce violent incidents in high-security psychiatric units.
England’s three highly secure psychiatric hospitals care for nearly a thousand patients deemed a grave and immediate danger at about £275,000 per year per patient.
Staff saying “no” to patients’ requests triggers a quarter of disruptive behaviour on secure wards, and staff off sick means fewer activities, less time in communal spaces and patients feeling less safe.
England’s biggest, oldest secure unit, Broadmoor, trialled a string of community activities picked by patients and staff in a study. Ward’s trialling activities had fewer physical and verbal attacks.
“This shows how important it is to develop and improve the social climate and sense of community on high-security wards,” said Dr Ignazio Puzzo at Brunel University London. “Improving the atmosphere reduces violence which positively impacts patients’ recovery and staff well-being.”
In the first study of this type on a high-security psychiatric hospital, psychologists spent 18 months investigating a pilot programme of social activities picked jointly or co-produced by staff and patients.
These include art exhibitions, barbecues, charity fundraising and a book of kindness. Six took part. Two put on many activities, two ran fewer but regular activities, and the remaining two kept their usual social activities.
The team monitored the effect these activities had on the social climate and sense of community in the participating wards.
Patients in high-security forensic psychiatric hospitals are often diagnosed with severe mental illnesses and personality disorders, putting themselves and others at a high risk of harm. Some may have committed crimes, including murder and grievous bodily harm. Some are in high security because of their high risk of violent assaults linked with their diagnosis.
Broadmoor Hospital in Berkshire is England’s oldest and biggest high-security psychiatric hospital. It has housed Kray twin Ronald Kray, Yorkshire Ripper Peter Sutcliffe and armed robber Charles Bronson now called Charles Salvador, recently up for parole.
In the wards where patients and staff put on co-produced social activities, there were fewer violent incidents, and both staff and patients reported a more positive social climate. Dr Puzzo said: “staff and patients want to collaborate on ward activities as they feel like this promotes a sense of safety, trust, and mutual support, thereby creating a therapeutic environment.”
“We have long known that a healthy ward climate can generate the foundation for new pro-social connections and relational security in forensic mental health care,” said Estelle Moore, head of Psychological Services, Broadmoor Hospital. “The findings of this important study provide us with the evidence.”