The social and therapeutic climate on general and forensic psychiatric wards with a special focus on objective and structural conditions of hospital settings

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During the years of the mental health movement in Western countries, the social climate of psychiatric wards (therapeutic climate, ward atmosphere) was an issue of research receiving a lot of interest. Whilst practitioners still are aware of its relevance, scientific interest has been rather low in recent decades. The Ward Atmosphere Scale by Rudolph Moos has been considered a gold standard of climate research up to now. But the 100 item questionnaire is a rather complex instrument, not adequate for recurrent application, and its 10-trait-concept has not been confirmed by statistical means. A short alternative instrument was developed at the University of Duisburg-Essen, the Essen Climate Evaluation Schema (EssenCES). The 15 item instrument, published in a number of language versions, assesses three climate traits: Patients Cohesion, Experienced Safety and Therapeutic Hold.One of the deficits of ward climate research was that objective and structural conditions of a ward setting have not received too much attention. Publications indicate a number of circumstances, being highly relevant for the ward climate, like ward size, the wards function and assignment, staffing level, level of security (restriction) and patients turnover.The research project suggested has a double target: Application of the EssenCES scale on 50 general psychiatric and 50 forensic psychiatric wards, allowing creating a scale manual covering both fields of psychiatric inpatient treatment. Identification of objective circumstances and conditions most relevant for the therapeutic climate of ward settings.Participating in the survey will cause little strain to mental hospitals. Only two to maximum four wards should participate per institution. Data are collected in a completely anonymised and confidential way, but hospitals may receive an individual feedback if management and ward staff agree.Substantial findings on the relation of ward conditions and therapeutic climate may serve as arguments when discussing the resources and staffing of psychiatric wards.