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Introduction
The treatment environment is as an important factor related to both treatment outcome and patient satisfaction for psychiatric inpatients (Friis, 1986; Eklund and Hansson, 1997; Melle et al., 1996; Røssberg et al., 2006; Smith et al., 1996). The Ward Atmosphere Scale (WAS) is the most commonly used instrument to measure important aspects of the treatment environment (Moos, 1997; Røssberg and Friis, 2003). Evaluation of the ward atmosphere in psychiatric wards treating patients with intellectual disability provides information on how the patients and the staff experience the ward atmosphere. Studies report that there are significant differences of perceived ward atmosphere between patients and staff members (Friis, 1986; Røssberg and Friis, 2004). Therefore, it is impossible to conclude how patients perceive the ward atmosphere from the staff scores only. Consequently, the main focus of the present study was on the patient scores.
Recent studies indicate an increased risk of psychiatric disorders in clients with intellectual disability (Smiley et al., 2007; Bakken et al., 2010). As in the general population, patients with intellectual disability and psychiatric disorders may need inpatient treatment when they experience severe symptoms of mental illness. Previous studies indicate that patient approval of the ward atmosphere is clearly related to positive treatment outcome (Melle et al., 1996; Eklund and Hansson, 1997). Efforts to develop milieu therapy for patients with intellectual disability and additional psychiatric illness may provide information about how psychiatric inpatients with intellectual disability perceive the treatment environment. To measure the treatment environment for patients with intellectual disability an instrument is required that reliably captures the patients' perception of the most important aspects of the treatment milieu.
However, there is a lack of studies examining such instruments for patients with intellectual disability. To our knowledge, only one study has used the WAS to examine the patients with intellectual disability perception of the treatment environment.
McGee and Woods (1978) used the WAS in a residential centre for adolescent students with mild and moderate intellectual disability in the USA. The ten students completed a short version of the WAS, encompassing 40 items. The 40 items were adapted to the participants and were presented verbally to the students during group settings with both staff and students. The authors reported that...