Staff perspectives of a violence intervention program in a forensic mental health hospital: Identification of environmental enablers and barriers to program implementation

Inpatient forensic mental health recovery often involves participation in offending behavior and mental health recovery-oriented psychological treatment programs. Various factors can impact a program's implementation into service, including environmental features of the hospital environment, such as its physical structure, routines, and the behavior of staff. Little research has explored staff perceptions of environmental features that enable or interfere with a program's implementation and therefore people's ability to participate in programs. Such research is necessary to ensure enablers are promoted and barriers are addressed to maximize treatment outcomes. The aim of this study was to explore staff perceptions of an intensive violence reduction program, the Life Minus Violence-Enhanced program, in a forensic mental health hospital, and elucidate environmental features that staff think may impact the program's delivery. Eight individual interviews with staff and senior clinical leaders were conducted over a 2-year period. Data were analyzed using reflexive thematic analysis. Nine major themes were identified. Results highlighted several environmental barriers that may impact the delivery of intervention programs and the ability of people in the hospital to participate. Importantly, findings suggest the need for programs to be valued by all staff, greater resourcing to be provided to ensure programs run effectively, and wider staff support to ensure new learning and skill development are supported outside of formal treatment sessions. Additionally, staff highlighted the need for a culture within the hospital that is supportive of intervention programs more broadly and integration of the program with other key rehabilitation and recovery activities.