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

Abstract

Patient participation is a central concept in modern health care and an important factor in theories/models such as person‐centred care, shared decision‐making, human rights approaches, and recovery‐oriented practice. Forensic psychiatric care involves the treatment of patients with serious mental illnesses who also have committed a crime, and there are known challenges for mental health staff to create a health‐promoting climate. The aim of the present study was to describe mental health professionals' perceptions of the concept of patient participation in forensic psychiatric care. Interviews were conducted with 19 professionals and were analysed with a phenomenographic approach. The findings are presented as three descriptive categories comprising five conceptions in an hierarchic order: 1. create prerequisites – to have good communication and to involve the patient, 2. adapt to forensic psychiatric care conditions – to take professional responsibility and to assess the patient’s current ability, and 3. progress – to encourage the patient to become more independent. The findings highlight the need for professionals to create prerequisites for patient participation through good communication and involving the patient, whilst adapting to forensic psychiatric care conditions by taking professional responsibility, assessing the patient’s ability, and encouraging the patient to become more independent without adding any risks to the care process. By creating such prerequisites adapted to the forensic psychiatric care, it is more likely that the patients will participate in their care and take more own responsibility for it, which also may be helpful in the patient recovery process.

Caregiver perspectives on patient capacities and institutional pathways to person centered forensic psychiatric care

“…The conflicting views from the participants regarding the actual presence of- and conditions for- patient participation in the care, as well as the tendency to equate participation and compliance, is consistent with what little research has been done in this area [ 9 , 10 ]. But it also highlights a challenge for the caregivers to distinguish in practice between necessary restrictions, caring ideals, and instrumentally motivated actions which are open to adjustment in cases of disagreement with patients.…”

“…The notion of PCC in FP, as in other highly coercive inpatient psychiatric care, has attracted increased advocacy in recent years [2][3][4][5]. At the same time, serious doubt has been raised around what this would imply, and to what extent it is compatible with the nature of this type of care [6], particularly in relation to patient capacities and the coercive institutional context [4,[7][8][9]. The notion of PCC is rather flexible, and need not assume one particular ethos or goal, so it remains open to analysis of the extent to which person-centered FP care is a viable notion.…”

Forensic psychiatric patients’ experiences of participating in administrative court proceedings concerning the continuation of forensic psychiatric care

“…Both staff and patients have reported patient participation being a challenge in forensic psychiatry in previous studies (11)(12)(13)(14)(15)(16). One reason may be that the forensic psychiatric process is difficult to understand and is experienced as being slow and complex.…”

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

“…In addition to being an ethical right (Lindberg et al, 2019), involving patients in decisions on their medication can support their adherence to treatment (NICE, 2009;Torrecilla-Olavarrieta et al, 2020) and help them to learn how to safely and effectively use PRN, based on their individual medication needs, to improve their quality of life. 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).…”

“…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.…”