The relationship between ward social climate, ward sense of community and incidents of disruptive behaviour: A study of a high secure psychiatric sample

BackgroundThe COVID-19 pandemic has had a substantial impact on forensic mental health service provision and implementation. This study aimed to provide an analysis of the impact of COVID-19 related restrictions on routine outcomes within a large forensic mental health service in London, UK.MethodWe conducted a longitudinal cohort study using data collected routinely prior to the COVID-19 pandemic (April 2018–March 2020) and then stages thereafter (March 2020–March 2021; analyzed as March–May 2020, June–September 2020, October–December 2020, January–March 2021). We used causal impact models (Bayesian structural time-series) to examine the effect of COVID-19 related changes on routine outcomes related to service provision and implementation.ResultsThere was an overall increase in long-term segregation (LTS) hours during the pandemic; 140%, (95% Cl 107, 171%) during Lockdown 1; 113%, (159% Cl 127, 192%) during post-Lockdown 1; 45% (95% Cl 23, 68%) during Lockdown 2 and, finally, 90% (95% Cl 63, 113%) during Lockdown 3. The most negative outcomes were evident during Lockdown 3. Incidents of violence were significantly more frequent during Lockdown 3 than would have been predicted based on pre-pandemic data, including physical assaults to service users (206%, 95% CI 57%, 346%), non-physical assaults to service users (206%, 95% CI 53%, 339%), and self-harm (71%, 95% CI 0.4%, 135%). Use of enforced medication also increased during Lockdown 3 (317%, 95% CI 175%, 456%).ConclusionThe pandemic and its related restrictions negatively affected some service outcomes. This resulted in increased incidents of violence and increased use of restrictive interventions, beyond what would have been expected had the pandemic not occurred.

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Background: Good reading skills are important for appropriate functioning in everyday life, scholastic performance, and the chances of acquiring a higher socioeconomic status. We conducted the first systematic review and meta-analysis to quantify possible deficits in specific reading skills in people with a variety of mental illnesses, including personality disorders. Methods: We performed a systematic search of databases (Academic Search Complete, CINAHL Plus, PsycInfo, PsycARTICLES, SocINDEX, MEDLINE, and PubMed) from inception until February 2020 and conducted random-effects meta-analyses. Results: The search yielded 34 studies with standardised assessments of reading skills in people with one or more mental illnesses. Of these, 19 studies provided data for the meta-analysis. Most studies (n=27; meta-analysis, n=17) were in people with schizophrenia and revealed large deficits in phonological processing (Hedge's g=-0.88, p<0.00001), comprehension (Hedge's g=-0.96, p<0.00001) and reading rate (Hedge's g=-1.22, p=0.002), relative to healthy controls; the single-word reading was less affected (Hedge's g=-0.70, p<0.00001). A few studies in affective disorders and non-forensic personality disorders suggested weaker deficits (for all, Hedge's g<-0.60). In forensic populations with personality disorders, there was evidence of marked phonological processing (Hedge's g=-0.85, p<0.0001) and comprehension deficits (Hedge's g=-0.95, p=0.0003). Conclusions: People with schizophrenia, and possibly forensic populations with personality disorders, demonstrate a range of reading skills deficits. Future studies are needed to establish how these deficits directly compare to those seen in developmental or acquired dyslexia and to explore the potential of dyslexia interventions to improve reading skills in these populations.

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