Social climate in forensic mental health settings: A systematic review of qualitative studies

- Social climate was defined as a multifactorial construct with seven factors.
- Existing measures do not account for all aspects of social climate.
- Patient, staff, environmental and system level factors can influence the social climate.
- Social climate contains dimensional constructs potentially amenable to intervention.

Social climate is a commonly evaluated aspect of inpatient forensic mental health settings. However, there is little clarity in the literature on the components of social climate. To identify these components, qualitative studies of staff and patient experiences of social climate were systematically reviewed using best fit framework synthesis. An a priori framework was developed based on nine existing models of social climate. A systematic search identified twenty studies of sufficient quality to be included in the review. These studies included staff and patient perspectives across all levels of inpatient forensic settings. In all twenty-two themes were identified in the review papers. From these themes, a model of social climate was developed. Seven factors were identified as part of the social climate, including the therapeutic relationship, care and treatment orientation, the secure base and four aspects of the ward environment. The findings indicate that common measures of social climate may not fully represent the construct. Themes related to the patient group, the staff group, the physical environment and system level factors were identified as influencing social climate. The model described allows for consideration of interventions to positively influence social climate.