Staff Experiences of Patient-Initiated Abuse Across Forensic Inpatient Wards

Objective: Staff in forensic inpatient services experience high rates of verbal and physical abuse
which has been linked to psychological distress, PTSD symptoms, and burnout, amongst others. Yet,
fewer studies have focused on the effect of racial abuse on staff members and little is known about
the frequency of racial abuse, nor the consequences it has on staff and patients. This study aimed to
explore the nature and experiences of racial abuse in forensic services.

Design: Due to a dearth of research concerning racial abuse in forensic services, a qualitative design
was chosen. Interviews were conducted at two low-and medium-secure NHS forensic wards in
England.

Methods: 26 patient-facing staff members were interviewed about their experiences of verbal abuse,
with particular attention to racial abuse, and physical abuse from patients. Transcripts were analyses
using an inductive thematic analysis approach.

Results: Racial abuse was highly prevalent for ethnic minority staff members. Both racial and physical
abuse had significant mental and physical consequences for staff, in addition to causing distress for
other patients and staff members who witnessed abuse. However, staff were also distressed by
reporting procedures, lack of appropriate support, and inappropriate consequences for patients who
commit criminal offences. Frequently, staff members felt they were coming to work to be abused.

Conclusions: Participants agreed that addressing racial abuse will be complicated and will require
ongoing work and policy changes. Racial harassment was not limited to patients, however, and some
staff members reported discriminatory behaviour by colleagues. Implications for forensic services are
discussed.