title: Service attachment: the relative contributions of ward climate perceptions and attachment anxiety and avoidance in male inpatients with psychosis.
abstract: BACKGROUND
  It has been suggested that mental health services can help meet the attachment needs of inpatients and improve patient outcomes through the provision of a 'secure base'; however, what defines the latter is unclear. Perception of ward climate might be a useful indicator.
  
  
  OBJECTIVE
  The aim of this study was to examine whether inpatient perceptions of the ward climate, which is partly under the control of the service, or inpatients' own personal levels of attachment anxiety and avoidance are more associated with their attachment to their service.
  
  
  METHODS
  Seventy-six men diagnosed with a psychotic illness, who were residents in one of four regional medium-security units in England, completed questionnaire measures of service attachment, personal attachment style and ward climate.
  
  
  RESULTS
  Ward climate was more strongly associated with service attachment than personal levels of attachment anxiety and avoidance. The most important aspect of ward climate for service attachment was the depth and influence of staff support for the inpatients.
  
  
  CONCLUSIONS
  Although patient characteristics are important influences on development of service attachment, ward climate is also important. The latter may be easily and reliably monitored with a brief questionnaire. Strategies to enhance and maintain its positive components are likely to be important for progress with forensic hospital inpatients who have a psychotic illness.
authors.affiliation: Ardenleigh, Birmingham and Solihull Mental Health Foundation Trust, 385 Kingsbury Road, Birmingham, B24 9SA, UK.
authors.forename: Roslyn
authors.initials: R
authors.lastname: Campbell
authors.forename: Steven
authors.initials: S
authors.lastname: Allan
authors.forename: Patrick
authors.initials: P
authors.lastname: Sims
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D001291:Attitude of Health Personnel; D004739:England; D005260:Female; D006757:Hospital Units / Q000458:organization & administration*; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration; D008875:Middle Aged; D009769:Object Attachment; D017060:Patient Satisfaction; D010465:Perception; D011369:Professional-Patient Relations; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D012931:Social Environment; D012938:Social Perception; D011795:Surveys and Questionnaires