Perceptions of procedural justice and coercion among forensic psychiatric patients: a study protocol for a prospective, mixed-methods investigation

Abstract

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

Patients' Views With Regard to Personal Recovery in Forensic Psychiatry in German-Speaking Switzerland—An Explorative Study

“…The patients in our focus groups partly reflect these charges against staff members in terms of a lack of support and mistrust, which contributes to the perception of an indirectly coercive institutional level in the corresponding wards. Procedural justice might be a key to overcome the perception of coercion ( 31 , 46 ), since the six crucial components of procedural justice described by Wittouck and VanderBecken ( 47 )—namely, fairness, voice, validation, respect, motivation, and trust and information—partly mirror demands and request of the patients in our interviews.…”

“…P2: Yes and strengthened the will to see for myself what I can do for my future, that has already given a strength of will." (FG 2, L. [45][46][47][48][49] Furthermore, the participants emphasized the value of the fact that the joint training was directed at both patients and staff members as equal partners in a scientific project, since this experience was perceived as a break with the conventions of the monotonous everyday life procedures of a forensic ward.…”

“…That's difficult." (FG 1, L. [41][42][43][44][45][46] Being confined restricts movement, but forced medication invades the body, and (that, at least, is the participant's fear) possibly changes the personality.…”

Forensic psychiatry in times of COVID-19: a qualitative study into the concerns and needs of patients

“…It is important that restrictions are deemed legitimate for patients to perceive them as less negative (Tomlin et al , 2020). Forensic patients may be more engaged and responsive to treatment if they perceive their involvement in the forensic system as procedurally just and legitimate (Simpson et al , 2020).…”

Nurses and the Discursive Construction of Procedural Justice in Review Board Hearings

“…In recent years, increased attention has been paid to the notion of procedural justice in mental health tribunals [1][2][3][4][5][6][7][8] and in mental health nursing. [9] Broadly de ned, procedural justice is the way in which individuals evaluate "the fairness of the processes by which legal authorities make decisions and treat members of the public [including themselves]".…”