Forensic mental health services: Measuring relational security


Relational security is an important component of care and risk assessment in mental health services, but the utility of available measures remains under-researched. The present study analyzed the psychometric properties of two relational security tools; the See Think Act (STA) scale and the Relational Security Explorer (RSE).

The researchers found that the STA scale had good internal consistency and could highlight differences between occupational groups, whereas the RSE did not perform well as a psychometric measure.

The measures provide unique and complementary perspectives on the quality of relational security within secure services but have some limitations. Use of the RSE should be restricted to its intended purpose; to guide team discussions about relational security, and services should refrain from collecting and aggregating this data.

Until further research validates their use, relational security measurement should be multidimensional and form part of a wider process of service quality assessment.Serious incident investigations in forensic mental health services have been linked to relational security breakdowns. 

However, relational security has been described as the ‘poor relation’ when compared with physical or procedural security. This is most likely due to definition difficulties. Chester & Morgan noted that numerous conceptualizations of relational security exist, all referencing different phenomena, such as ‘therapeutic relationships’ and ‘boundaries’, without describing how such concepts can affect security. 

The authors noted that the most practically useful definitions emphasize exactly how relational issues affect security, in two stages:

(1) staff knowledge of patients and therapeutic relationships; and

(2) how patient knowledge and therapeutic relationships are used to foresee potential and manage actual security incidents.

For instance, the professional relationships between staff and patients so that the staff to get to know their patients, their moods and problems, to facilitate interventions before these become major problems, or lead to incidents of a security nature. As such, relational security is intrinsically linked to short- and long-term assessment and management of risk in mental health and forensic services.

Relational security is, therefore, a service quality indicator of interest within forensic and general mental health services. Its measurement should allow practitioners to explore background causes and respond accordingly with appropriate interventions. Due to the definitional complexities, there are subsequent challenges to measurement.

Previously available tools only measure partial aspects of relational security or individual patient needs. However, two tools have been developed in recent years, the Relational Security Explorer and the See Think Act scale. As limited research has examined the clinical utility of these measures, the present study examines their psychometric properties to support the aim of relational security measurement.