An Interview Study of Professional Carers’ Experiences of Supporting Patient Participation in a Maximum Security Forensic Psychiatric Setting

Abstract

Patient participation in forensic psychiatric settings seems to be complex by nature, and previous studies show that patients rate their participation as lower in this context compared to general psychiatric contexts. Studies on caregivers' perspective could provide a clearer picture of the components and possibilities of patient participation in forensic psychiatry. The aim of the study is to describe carers' experiences in supporting patient participation in a maximum security forensic psychiatric care setting. Twelve psychiatric caregivers were interviewed about how they support patients' participation. The result shows that a complexity of patient participation emerges as a difficult act of balancing the paradoxical role of caring for the patient's interests and development, while simultaneously representing and adhering to the rules and regulations of the system in which one is employed. In conclusion, it is suggested that participation is comprehended as an umbrella term and that focus is directed to conceptualising what caregivers can do in order to create positive patient-carer relationships, as well as what constitutes such a relationship.

Patient participation in forensic psychiatric care: Mental health professionals' perspective

“…Söderberg et al . (2019) describe this as a good relationship: not participation but the next best thing . Full participation can perhaps not be achieved, but by building good relations with patients through trust, security, and communication, conditions for supporting patient participation are created.…”

“…Söderberg et al . (2019) emphasize the difficulty of balancing the paradoxical role of caring for the patient’s interests and development, whilst simultaneously representing and adhering to the rules and regulations in the system in which one is employed. However, based on the complexity of both the concept and the setting itself, we believe that knowledge about the concept in this context is missing.…”

Patient Participation in Pro Re Nata Medication in Forensic Psychiatric Care: Interview Study with Patients and Nurses

“…However, forensic psychiatric patients are particularly vulnerable when it comes to participation due to their poor mental health status and the involuntary nature of treatment (Selvin et al, 2016(Selvin et al, , 2021. In addition, patient participation has been threatened by power imbalances between patients and staff (H€ orberg & Dahlberg, 2015;S€ oderberg et al, 2020) and paternalistic treatment cultures (Haines et al, 2018;Selvin et al, 2016). Forensic inpatients have reported their willingness to participate (Selvin et al, 2016) and provide opinions on their care (Marklund et al, 2020).…”

“…Forensic inpatients have reported their willingness to participate (Selvin et al, 2016) and provide opinions on their care (Marklund et al, 2020). Nonetheless, patients' participation has been found to be limited (Eidhammer et al, 2014;Haines et al, 2018;S€ oderberg et al, 2020), and patients have rated patient participation as the lowestquality aspect of their care (Schr€ oder et al, 2016).…”

“…In addition, nurses working in acute care have had more experiences of ineffective PRN, and they are more confident in using alternative interventions. Previous studies in forensic care have focused on PRN medication (Barr et al, 2018) or patient participation (Magnusson et al, 2020;Selvin et al, 2016Selvin et al, , 2021S€ oderberg et al, 2020), but research on patient participation in PRN in forensic psychiatric settings is lacking.…”