Elien Neimeijer

44 restricting the client’s freedom using coercive measures (Hui, Middleton, & Völlm, 2016). In secure forensic settings, coercive measures can take the form of seclusion (placement of a client alone in a locked room that has been designed for this purpose or in a client’s room), restraint, involuntary medication, and involuntary food and/or fluids. Researchers, care organisations, the inspection for Dutch Health Care, labour in- stitutions and other partners in health care stated in the last two decades that the use of coercion should be minimised (Kersting et al., 2019; Knotter, 2019). Coercive measures should be limited to situations in which staff and other clients at the living group need to be protected from aggressive behaviour as a last resort when acute danger or harm is likely (De Valk et al., 2016). Coercive measures often do not prevent the aggressive behaviour of clients in the long term but, paradoxically, may strengthen and maintain it (Knotter, Wissink, Moonen, Stams, & Jansen, 2013; Parhar, Wormith, Derkzen, & Beau- regard, 2008). Coercion was described by Van Der Helm et al. (2014) as part of a struc- ture in secure forensic settings that is necessary to set boundaries and prevent chaos and anarchy. However, the degree of coercion should always be proportional in relation to ‘dangerousness’ to avoid institutional repression. Institutional repression threatens, and may even harm, the effectiveness of secure (forensic) treatment, and therefore must be prevented. (De Valk et al., 2015, 2016). Coercive measures should be limited to situations in which staff and other clients at the living group need to be protected from aggressive behaviour as a last resort when acute danger or harm is likely The current study examines the association between the group climate, aggressive in- cidents, and coercive measures in a secure forensic setting for clients with MID-BIF. While there is (preliminary) evidence for the importance of group climate in managing aggressive incidents in residential youth care (De Decker et al., 2018; Van den Tillaart et al., 2018), secure forensic and psychiatric settings (Robinson et al., 2018; Ros et al., 2013), and prison settings (Akerman, Needs, & Bainbridge, 2018), little attention has been paid to group climate and its relation to aggressive incidents in secure forensic settings for individuals with mild intellectual disability or borderline intellectual functioning. This is striking considering that aggression in Dutch health care for people with intellectual disabilities (CNV Zorg & Welzijn, 2018) as well as in forensic health-care settings in many countries (Robinson et al., 2018) is recognised as a significant problem. Based on