The EssenCES Measure of Ward Atmosphere: Mokken Scaling, Confirmatory Factor Analysis, and Investigating Patient-Level Characteristics

Ward atmosphere is an important aspect of forensic mental health care. Positive perceptions have been linked to satisfaction during treatment, quality of life, autonomy, involvement in care, emotional expression and lower rates of aggression. The EssenCES is one of the most widely used measures of ward atmosphere. This study sought to add to the psychometric evidence base for the EssenCES and improve our understanding of how perceptions of ward atmosphere are associated with patient-level factors. N = 233 patients in English low, medium and high security hospitals completed the EssenCES, and data were collected on patient age, length of stay in current institution, level of security, ethnicity, Mental Health Act 1983 section, and mental health diagnosis. We used Mokken scaling, confirmatory factor analysis and multiple linear regression. Our analysis supports the three-factor structure of the EssenCES but signposts areas for improvement, specifically, revising and retesting items 10, 13 and 16. We found that Black, Asian and Minority Ethnic patients report lower Experienced Safety domain scores and that patients with a personality disorder diagnosis report lower Therapeutic Hold domain and EssenCES total scores, when controlling for other variables. We suggest future lines of research and situate our findings in the wider literature.