Clinician Perspectives of Inpatient Forensic Psychiatric Rehabilitation in a Low Secure Setting: A Qualitative Study

Abstract

There is a dearth of research into what low secure forensic psychiatric rehabilitation means in Australia and internationally. The aim of this study was to understand clinician perspectives of forensic psychiatric rehabilitation in a low secure setting in Australia and offer insight into a model of care. A qualitative methodology was chosen with separate semi-structured interviews being conducted with staff members involved in decision-making for forensic psychiatric patients in a rehabilitation unit. Analysis of the interviews identified three domains that the questions related to: 'defining and describing security', 'defining and describing low secure forensic psychiatric rehabilitation' and 'describing the role of staff and services in a low secure forensic psychiatric rehabilitation setting'. Where relevant, themes were abstracted from the questions that related to these domains. This study revealed that clinicians had a varied understanding of definitions for security but a similar understanding of what low secure forensic psychiatric rehabilitation means, what patients are suitable and the general goals of rehabilitation in this setting. Further research is needed on low secure rehabilitation and specific models of care. There is also a need to develop clear definitions for both security and rehabilitation in low secure forensic psychiatric settings.

Characteristics and outcomes of patients with intellectual disability admitted to a specialist inpatient rehabilitation service

“…It is possible that the Assuring Transformation Data (NHS England, n.d.) may provide similar answers relative to rehabilitation. Furthermore, recent research suggested that clinicians had a thorough understanding of the characteristics of rehabilitation services, which patients are suitable, and the treatment and support goals in a forensic rehabilitation service in Australia (Khan et al, 2017). The authors conducted semi-structured interviews, highlighting that staff emphasized higher degrees of relational and procedural security, and lower degrees of physical security, emphasis on skill development and increasing independence, and working to support patients to understand the clinical and social factors which may lead to reoffending, through supervised and unsupervised access to the community, where patients have access to potential destabilizers, such as drugs and alcohol.…”

“…The authors conducted semi-structured interviews, highlighting that staff emphasized higher degrees of relational and procedural security, and lower degrees of physical security, emphasis on skill development and increasing independence, and working to support patients to understand the clinical and social factors which may lead to reoffending, through supervised and unsupervised access to the community, where patients have access to potential destabilizers, such as drugs and alcohol. Staff also discussed the need for support at this critical time in a patient’s care pathway, ‘it is a stepping stone for forensic patients to re-engage in community living’ (Khan et al, 2017: 5).…”