Understanding therapeutic climate in intellectual disability secure services: a thematic analysis of service user perspectives
Kooner, Gavin Hickman, Gareth
Kooner, Gavin
Hickman, Gareth
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Originality/value
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.
MIDER Authors
Affiliations
Coventry and Warwickshire Partnership NHS Trust
Date
2026-06
Type
Article
Collections
Citation
Kooner G, Hickman G (2026;), "Understanding therapeutic climate in intellectual disability secure services: a thematic analysis of service user perspectives". Advances in Mental Health and Intellectual Disabilities, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/AMHID-03-2026-0019