Background: The risk and recovery paradigms are the dominant frameworks informing forensic mental health services and have been the focus of increasing research interest. Despite this, there are significant gaps in our understanding of the nature of mental health recovery in forensic settings (i.e., 'secure recovery'), and specifically, the key elements of recovery as perceived by forensic patients and their treatment providers. Importantly, we know little about how patients perceive the forensic mental health system, to what extent they see it as fair and legitimate, and how these perceptions impact upon treatment engagement, risk for adversity, and progress in recovery. Methods: In this prospective, mixed-methods study, we investigate patient perceptions of procedural justice and coercion within the context of the forensic mental health system in Ontario, Canada (final N = 120 forensic patients and their primary care providers). We elicit patient self-assessments of risk and progress in recovery, and assess the degree of concordance with clinician-rated estimates of these constructs. Both qualitative and quantitative methods are used to assess the degree to which patient perceptions of coercion, fairness and legitimacy impact upon their level of treatment engagement, risk for adversity and progress in recovery. A prospective, two-year follow-up will investigate the impact of patient and clinician perspectives on outcomes in the domains of forensic hospital readmission, criminal reoffending, and rate of progress through the forensic system. Discussion: Results from this mixed-methods study will yield a rich and detailed account of patient perceptions of the forensic mental health system, and specifically whether perceptions of procedural fairness, justice and legitimacy, as well as perceived coercion, systematically influence patients' risk for adversity, their ability to progress in their recovery, and ultimately, advance through the forensic system towards successful community living. Findings will provide conceptual clarity to the key elements of secure recovery, and

This study describes the recovery experiences of persons who have been found not criminally responsible on account of a mental disorder (NCRMD). A qualitative descriptive methodology was used to elicit the recovery experiences of five participants. The overarching theme that arose from the data was ‘Experiencing and understanding recovery in the forensic mental health system (FMHS) as a dynamic process of change,’ and the major themes that emerged out of the overarching theme are: ‘Recovering in the FMHS,’ ‘the Critical Role of Medication,’ ‘the Significance of Relationships,’ ‘the Importance of Helping Yourself,’ and ‘Navigating Challenges.’ The results of this inquiry reveal that the participants’ experiences of recovery are greatly influenced by their involvement in the FMHS. This study offers a preliminary understanding of how recovery is experienced by NCRMD clients who reside in the community and suggests implications for clinical practice and education, as well as future research and theory.

This study describes the recovery experiences of persons who have been found not criminally responsible on account of a mental disorder (NCRMD). A qualitative descriptive methodology was used to elicit the recovery experiences of five participants. The overarching theme that arose from the data was ‘Experiencing and understanding recovery in the forensic mental health system (FMHS) as a dynamic process of change,’ and the major themes that emerged out of the overarching theme are: ‘Recovering in the FMHS,’ ‘the Critical Role of Medication,’ ‘the Significance of Relationships,’ ‘the Importance of Helping Yourself,’ and ‘Navigating Challenges.’ The results of this inquiry reveal that the participants’ experiences of recovery are greatly influenced by their involvement in the FMHS. This study offers a preliminary understanding of how recovery is experienced by NCRMD clients who reside in the community and suggests implications for clinical practice and education, as well as future research and theory.