Abstract
Forensic inpatient settings are extremely difficult spaces to work and reside in. Social
climate is a term used to describe the physical, social and emotional conditions that contribute
to how staff and patients perceive and experience the forensic environment. Tensions between
risk of violence, safety and therapeutic care can lead the social climate of forensic wards to be
challenging. On forensic wards caring for patients diagnosed with Borderline Personality
Disorder (BPD), the social climate is considered to be especially difficult. The early trauma
and interpersonal difficulties typically experienced by individuals with BPD can act as barriers
to therapeutic relationships in secure settings, which in turn affect the broader social climate.
Sadly, ruptures in therapeutic relationships can influence staff in forensic settings to respond
to the distressed emotions and behaviours of patients with BPD in ways that are unhelpful and
potentially traumatising in their own right. This thesis aimed to explore how the experiences
and behaviours of patients with BPD and the staff who support them on secure wards, can
influence the social climate of forensic settings.
Part A of this thesis presents a conceptual review that uses a Trauma-Informed Care
(TIC) framework to critique the physical, social and emotional conditions of social climate in
forensic settings caring for patients with BPD. The review suggests that for patients with BPD,
previous trauma likely influences their perceptions of and responses to the social climate of
forensic settings, leading aspects of the ward environment to be experienced as retraumatising.
The review advocates that implementation of TIC on forensic wards caring for patients with
BPD could evoke positive shifts in the social climate, working to reduce the risk of
retraumatisation. Part B of the thesis presents a Reflexive Thematic Analysis exploring
interpersonal relationships and social climate on forensic wards caring for patients with BPD,
from the perspective of ward staff. Six interrelated themes were generated; three describe
relational cycles that occur between ward staff and patients with BPD, and three describe
systemic factors that influence the wider context within which ward staff operate. From these
themes, a model (SCOFS-BPD) was developed to summarise how factors in the wider forensic
system and the interpersonal relationships between staff and patients with BPD on forensic
wards influence one another, affecting staff experiences of the social climate of forensic
settings.
It is important to share that the development of this research was not uncomplicated,
and several barriers were met by the author which led the project to be revisited. Firstly, the
initial proposal for the research included a second qualitative empirical study which aimed to
explore the experiences of interpersonal relationships and social climate of forensic settings,
from the perspective of forensic patients with BPD. Despite the study being considered a
valuable contribution to the literature and receiving ethical approval, barriers to recruitment
faced by the author led to the project being discontinued. This outcome was disappointing, as
the author’s motivation for the project was to provide a space for the voices of forensic patients
with BPD to be heard within research. It is thus hoped that with a longer timeframe, this study
can be revisited at a later date. This being said, the relinquishment of this study gave way to
the conceptual review in this thesis, which is considered an equally valuable contribution to
the literature. Secondly, difficulties were also experienced by the author in recruiting ward staff
to participate in the research. Despite many attempts to encourage recruitment and earn the
trust of staff across participating forensic units, the author was faced with apprehension and
some hostility from ward staff. This led the author to gain an ethical amendment that allowed
the recruitment of participants through other means, such as social networking sites. The
clinical implications of these issues are reflected on throughout the papers in this thesis.