Therapeutic Milieu Approaches within The State Hospital: A Qualitative Analysis of Patients' Experiences of Ward Talking Groups Jacqueline Geddes University of Edinburgh/The State Hospital

Developing “a positive therapeutic milieu” Within forensic mental health services all staff must be alert to physical and procedural structures/processes due to the increased likelihood of violence and aggression. This inevitably has an impact on the relationships between staff and patients. In an attempt to address this imbalance, the clinical model proposed the development of a ‘positive therapeutic milieu‘.

Developing “a positive therapeutic milieu” In order to develop a positive therapeutic environment, it was essential to identify therapeutic components within the evidence base that have been found to be effective.

Developing “a positive therapeutic milieu” Vandevelde et al.’s (2004) retrospective account of the democratic Maxwell Jones type Therapeutic Community (Jones, 1952, 1968) and the Hierarchical Concept-based Therapeutic Community (Yablonsky, 1965; Bratter et al, 1985) explores the similarities and differences between them.

Developing “a positive therapeutic milieu” Although both approaches are borne from these diverse roots, Vandevelde et al. (2004) highlights the links between them with regard to: Social learning and behavioural modification Permissiveness and modeling Democracy and hierarchy Communalism and community as method Reality testing and acting as if

Developing “a positive therapeutic milieu” Perry’s (2012) systematic review of successful components of milieu approaches echoed Vandevelde’s account. The components found in the literature were: Using the community as a therapeutic tool Social learning Reality testing Permissiveness Patient participation Psycho-education

Why ward talking groups? To capitalise upon the evidence for these six shared- components of successful milieus. The issue of high expressed emotion in community meetings.

This study Although these groups have been developed in an attempt to provide more opportunities for therapeutic interactions between staff and patients, it is recognised these groups are a novel therapeutic intervention. As a result of this, patient’s subjective experience of these groups is unclear. There is a need to explore these experiences in order to evaluate the processes in these groups and assist in service development.

Methodology Interpretive Phenomological Analysis (IPA) Recruitment Inclusion and Exclusion Criteria Participant Characteristics Materials Ethical Review Data Collection

Why IPA? To provide insight into how services feel ‘from the inside’ (Rose, 2003, p.406). The importance of the subjective experience of offenders on their life changes (Farrall, 2002).

Findings Relating to Others Building & improving relationships Being heard Sharing experiences Negotiating difficult social situations

Findings Rights within the context of high security Choice Freedom of speech Negotiating boundaries Equality

Findings The challenge of something new Ambivalence towards new processes Previous experiences shaping current understanding The importance of information Being open-minded

Findings Breaking down barriers to social interaction Informal Normalising Negotiable boundaries Versatility