Study: Community spirit quells violence in high security psychiatric hospitals

Positive vibes, bonding activities and getting on well with each other help reduce violent incidents in high security psychiatric units, research suggests.

England's three high secure psychiatric hospitals care for nearly a thousand patients deemed "a grave and immediate danger" at a cost of about £275,000 per year per patient.

Staff saying "no" to patient's requests triggers a quarter of disruptive behavior on secure wards and staff off sick means fewer activities, less time in communal spaces and patients feel less safe.

England's biggest, oldest secure unit, Broadmoor trialed a string of community activities picked by patients and staff in a study published in the Journal of Forensic Psychiatry and Psychology. Wards trialing 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 program 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 wards took part in the program. Two put on a wide range of activities, two ran fewer but regular activities and the remaining two kept their usual social activities. The team monitored what effect these activities had on social climate and sense of community on the wards.

Patients in high security forensic psychiatric hospitals are often diagnosed with severe mental illnesses and personality disorders which put 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 very high risk of violent assaults linked with their diagnosis.

Broadmoor Hospital in Berkshire is England's oldest and biggest high security psychiatric hospital and 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 not only fewer violent incidents but 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."