title: Social climate along the pathway of care in women's secure mental health service: variation with level of security, patient motivation, therapeutic alliance and level of disturbance.
abstract: BACKGROUND
  Social climate has been measured in a variety of therapeutic settings, but there is little information about it in secure mental health services, or how it may vary along a gender specific care pathway.
  
  
  OBJECTIVE
  To assess social climate in women's secure wards and its variation by level of security and ward type, therapeutic alliance, patient motivation, treatment engagement and disturbed behaviour.
  
  
  METHODS
  Three-quarters (80, 76%) of staff and nearly all (65, 92%) of patients in the two medium-security wards and two low-security wards that comprised the unit completed the Essen Climate Evaluation Schema (EssenCES) and the California Psychotherapy Alliance Scale (CALPAS); patients also completed the Patient Motivation Inventory (PMI). Pre-assessment levels of disturbed behaviour and treatment engagement were recorded.
  
  
  RESULTS
  Social climate varied according to ward type and level of security. EssenCES ratings indicative of positive social climate were associated with lower levels of security; such ratings were also associated with lower behavioural disturbance and with higher levels of motivation, treatment engagement and therapeutic alliance.
  
  
  CONCLUSIONS
  This serial cross-sectional survey indicated that use of the EssenCES alone might be a good practical measure of treatment progress/responsivity. A longitudinal study would be an important next step in establishing the extent to which it would be useful in this regard.
authors.affiliation: St. Andrews Healthcare, Northampton, UK. clong@standrew.co.uk
authors.forename: C G
authors.initials: CG
authors.lastname: Long
authors.forename: K
authors.initials: K
authors.lastname: Anagnostakis
authors.forename: E
authors.initials: E
authors.lastname: Fox
authors.forename: P
authors.initials: P
authors.lastname: Silaule
authors.forename: J
authors.initials: J
authors.lastname: Somers
authors.forename: R
authors.initials: R
authors.lastname: West
authors.forename: A
authors.initials: A
authors.lastname: Webster
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006778:Hospitals, Psychiatric; D006801:Humans; D008605:Mental Health Services; D008875:Middle Aged; D009042:Motivation; D011329:Prisoners / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012919:Social Behavior; D012931:Social Environment; D055815:Young Adult