The purpose of this paper is to better understand how inpatients with Intellectual Disabilities (ID) make sense of the therapeutic climate in their secure units, particularly in terms of therapeutic hold, patient cohesion and safety.
This study uses Thematic Analysis to analyse the qualitative comments collected using the Intellectual and Developmental Disabilities adaptation of the Essen Climate Evaluation Schema (EssenCES-IDD) in Medium and Low Secure services. Three years of data collected as part of routine clinical care were retrospectively analysed from detained patients in ID secure services.
Under the three superordinate themes of Therapeutic Hold, Patient Cohesion and Experienced Safety, relational consistency emerged as a unifying mechanism underpinning positive experiences of care. When staff were experienced as familiar, emotionally available and reliable, participants reported greater therapeutic engagement, improved peer relationships and enhanced feelings of safety.
This study contributes to a limited evidence base exploring ward climate from the perspective of patients with ID in secure settings. By analysing the qualitative data generated by the EssenCES-IDD, it provides novel insight into how safety is subjectively experienced within these environments.
