Service attachment : the relative contributions of ward climate perceptions and attachment anxiety and avoidance in male inpatients with psychosis

Part One: Literature Review.;Title: The Influence of Ward Atmosphere on Male Inpatients with Psychosis.;The purpose of this review was to examine the literature relating to the influence of ward atmosphere on inpatients with a diagnosis of psychosis. A systematic search strategy was used to identify the relevant literature. A methodological critique and data synthesis of all studies fulfilling the inclusion criteria was then conducted. Nineteen studies in total were critically evaluated. The results highlighted that the ward atmosphere can have a positive impact on patient outcomes such as psychotic symptomatology, mood, attitude, and more general functioning, when it is enhanced to better suit the needs of those with psychosis. Furthermore, many studies highlighted that an ideal ward atmosphere for individuals with a diagnosis of psychosis is calm and supportive and has low levels of "anger and staff control". However, many of these studies had their own limitations, such as small sample sizes and lack of longitudinal studies. More research is needed within this area, particularly with regards to more UK based longitudinal studies with larger sample sizes.;Part Two: Research Report.;Title: Service Attachment: The Relative Contributions of Ward Climate Perceptions and Attachment Anxiety and Avoidance in Male Inpatients with Psychosis .;Present literature suggests that the relationship between mental health services and their clients is becoming increasingly important, particularly since current thinking pertains to the idea that mental health care institutions can represent a positive attachment figure for inpatients. Service attachment relates to mental health services' ability to meet the attachment needs of patients through the provision of a "secure base", which the attachment literature suggests should be the prime function of mental health services. This "secure base" provision is an important consideration, particularly for forensic inpatients where there is a predominance of insecure attachment styles, fragmented attachment histories, and frequent episodes of distress related to their diagnosis of psychosis. The purpose of the current cross-sectional study was to assess whether inpatient perceptions of the ward climate, or their level of attachment anxiety and avoidance, had a greater contribution to their attachment to a service. Male inpatients with a diagnosis of psychosis (N = 76) residing in four regional Medium Secure Units completed questionnaire measures of service attachment, attachment style, and ward climate. Variables were analysed using Pearson product-moment correlations and hierarchical multiple regressions, controlling for negative affect. Results indicated that perceptions of the ward climate contributed more significantly than attachment anxiety and avoidance to service attachment. Furthermore, the element of the ward climate relating to positive therapeutic relationships between staff and patients was more contributory to service attachment over other aspects of the ward climate. The results also highlighted a strong influence of state negative affect on all the measures within the current study highlighting that negative affect should be considered as a main variable in future research rather than solely as a control. Clinical implications relating to the importance of considering the ward environment in inpatient settings and the role of staff supervision and training is discussed.;Part Three: Critical Appraisal.;A reflection on the overall research project is provided. Issues relating to gaining access to and working with this population are discussed.