“Them two are around when I need their help” The importance of good relationships in supporting people with learning disabilities to be “in a good space”

Accessible summary We talked to people who lived in a secure unit and their staff. We asked them about good relationships with each other. The majority of the people said that good relationships with staff can help people move back to the community and be “in a good space”. Staff said that good relationships can stop people feeling angry. They said that they like to help people and have trust. It is important to have a good staff team who know the person well. Residents said staff help them and listen to them when they are upset. They said they like it when staff spend time with them doing activities. Based on what residents told us, we think it is important that services work on helping people to have good relationships. This is because these relationships were very important in helping people to move more quickly back into the community. Please see an easier to read version here: https://wp.me/pcRSAn-3V Background Despite repeated policy initiatives, an enduring number of people with learning disabilities remain resident in secure settings (also referred to as locked wards). The spatial and emotional distance from family and friends means that relationships with staff become central to people's lives, and are critical for a successful transition to making their home in the community.

Methods This article uses a synthesis of evidence from two qualitative studies. We re-analysed data from fieldnotes and interview transcripts with people with learning disabilities resident in secure settings and with staff who worked with them. The purpose of the original studies was service improvement however, relationships —particularly with between staff and residents— emerged as a significant theme in both studies. Therefore, the data were revisited to explore these relationships in more depth.

Findings The analysis identified that positive relationships with staff were critical in enabling residents to be “in a good space”—something they and staff viewed as a crucial factor for moving on. The analysis identified four main themes: (i) the characteristics of positive relationships, (ii) the challenges for positive relationships, (iii) how positive relationships can be encouraged and (iv) how positive relationships support people to move on.

Conclusion We conclude that flattening the hierarchy between staff and residents is key when supporting people with learning disabilities to move on. We stress the importance of the “soft skills” in enabling people to transition back to their community. There is a pressing need for research with people who have made the transition from hospital to generate retrospective narratives about what elements of these relationships are most significant in supporting a successful transition.