A study of the degree of alignment between mental health practitioners' understanding of patients, resident in secure mental health hospital settings, who have been abused in childhood and/or adolescence
Childhood abuse and neglect, as suffered by in-patients of medium secure psychiatric hospitals, is an under-researched clinical variable within the literature. Associated study and work in this area is considered to be a core skill of the forensic mental health nurse (FMHN), as well as of other clinicians working in such hospitals. The study undertook an examination of childhood abuse and neglect in three medium secure units (n= 117), finding that 41% of the sample suffered abuse/neglect in childhood/adolescence. An examination of a wide range of patient characteristics in the units was also conducted, findings included observations of 94% of patients having committed a violent index offence, and 81.2% of patients being diagnosed with schizophrenia. A hypothesis test conducted on this data revealed a significant relationship between the gender of patients and abuse/neglect suffered in childhood. A further analysis of inter-rater reliability was undertaken, of FMHN's and Nurse Consultants against a Benchmark nurse, in rating the severity of abuse suffered by inpatients. This revealed findings of both fair to moderate, and poor agreement, between the nurses, Nurse Consultants and Benchmark nurse. Allied study of a range of clinicians knowledge and opinions concerning agreement or disagreement with statements related to concepts of abuse, mental disorder and violence revealed mixed results, dependent upon either a quantitative analysis indicating no variation amongst the clinician's, or qualitative analysis identifying some specific differences. The study overall has concluded that the use of a mixed methodology is beneficial to examining consistency of agreement, and knowledge and opinions, regarding clinical phenomena amongst clinicians. The study makes recommendations in terms of adjustments to forensic educational curricula and clinical practice, regarding inclusion of more, and improved, information concerning childhood abuse and neglect.