Factors Affecting Treatment Regress and Progress in Forensic Psychiatry: A Thematic Analysis

Abstract

International variability and shifting trends in forensic psychiatry lead to gaps in national service provision and needs for service development. This study explores these needs through the subjective narratives of those involved in Finnish forensic services, either as forensic psychiatric patients, their parents, or service providers. Data was gathered by means of thematic interview and subjected to thematic analysis. Three main themes emerged: (1) pre-treatment challenges, (2) institutional/treatment-related concerns about therapeutic security and (3) adapting and recovery. The research highlights the need to develop forensic psychiatric services at three levels. First, it calls for increased risk awareness and risk assessment skills at the general psychiatric level. Second, it emphasizes the need for increased therapeutic engagement throughout the rehabilitative process. Third, it calls for structured and meaningful post-discharge aftercare. At all three levels, gradated security-aware standardization and patient triage in forensic services would help to develop and maintain an intact care pathway. This would decrease offending, marginalization, and suffering. Only then can we begin to meet the requirements of the WHO European Mental Health Action Plan. These findings can contribute to the development of international, standardized treatment models for clinical forensic psychiatric practices.

Nurses' and patient' descriptions about forms of power in pro re nata medication participation in forensic psychiatric care: A qualitative secondary analysis

“…It is indeed a challenge to create a treatment environment that supports forensic psychiatric patients' empowerment in their own care, as the care is coercive and patients are treated involuntarily (Selvin et al, 2019). However, creating an accepting and trustful treatment relationship should be a target as it is pivotal to treatment adherence and rehabilitation (Askola et al, 2022).…”

Forensic Psychiatric Patients' Experiences of Personal Recovery

“…The archetype of a forensic hospital traditionally serves as a place for "imposed" recovery, as it deprives patients of their freedom to choose their own path of recovery (McKenna et al, 2014). Lengthy treatment periods are typical for different kinds of patients in forensic hospitals (Askola et al, 2022).…”

“…However, it is common for forensic hospitals to strike a balance between patient empowerment and institutional control during the care process (Schoppmann et al, 2021; Senneseth et al, 2022; Tomlin et al, 2018). Forensic hospitals typically treat forensic patients, but in some countries, psychiatric patients who are dangerous and so severely mentally ill that they cannot be treated in general psychiatry may be treated in a forensic hospital (Askola et al, 2022). In forensic hospitals, patients are detained in closed environments because of their mental illness and because they have offended or are at risk of offending (Livingston et al, 2013; Nijdam-Jones et al, 2015).…”

“…In the case of forensic patients, a criminal history and long-term psychiatric illness affect the patients' possibilities to pursue their own goals (Clarke et al, 2016;Drennan & Alred, 2012;Slade et al, 2014). The legal stipulations because of the forensic patients' offending history may affect their possibilities to leave the hospital (Askola et al, 2022). We conducted a concept analysis to define forensic patients' personal experiences of recovery and propose how personal recovery can be promoted in forensic psychiatric hospital care.…”

“…Nevertheless, there are certain studies that comprehensively describe both the patients' experiences of recovery in forensic hospitals and helpful forms of care (e.g., Clarke et al, 2016; Senneseth et al, 2022; Shepherd et al, 2016). The patient populations of forensic psychiatric hospitals differ from one country to another (Askola et al, 2022). When referring to forensic patients in this article, we mean patients who have offended.…”