Reducing or Increasing Violence in Forensic Care: A Qualitative Study of Inpatient Experiences

‘The Art of Understanding in Forensic Psychiatric Care’ – From a Caring Science Perspective Based on a Lifeworld Approach

“…In such caring situations, a lifeworld approach offers the opportunity of understanding how the carer can encounter the patient. Olsson et al (2015), who studied factors that can reduce or increase the risk for violence in forensic psychiatric care from the patient's perspective, show that the responses and attitudes of carers, the patient's own insights and attitudes as well as interactions within the healthcare environment, are all important in this context. All areas, where the risk of violence can be reduced, are related to the patient being allowed to be a person and to be seen and understood as a subject.…”

“…Gustafsson et al (2013) suggest that it is about being treated with dignity and respect and being able to talk to someone when the need arises. Olsson et al (2015) show that the risk for violence increased when carers were dismissive and confrontational, which could lead to an escalation of conflicts. On the other hand, an interior dialogue and healthy alliances with both carers and other patients contributed to a reduction in the risk for violence.…”

“…They need, however, to be understood, encountered and treated as the people they are, in common with other vulnerable people in need of care. At the same time, the carers have to maintain a security perspective (Olsson, Audulv, Strand, & Kristiansen, 2015;Olsson, Strand, Asplund, & Kristiansen, 2014a;Olsson, Strand, & Kristiansen, 2014b) as well as providing a dignified care (Gustafsson, Wigerblad, & Lindwall, 2013, 2014.…”

‘I know what I need to recover’: Patients’ experiences and perceptions of forensic psychiatric inpatient care

“…When we reviewed the recent literature on patients’ perspectives on forensic psychiatric inpatient care, we identified conflicting but mostly negative experiences. Forensic care is experienced as predominantly non‐caring but with small pockets of good care (Hörberg et al )where being punished and threatened with consequences are parts of daily life (Hörberg et al ; Olsson et al ). Staff refusing to understand patients’ perspectives or treating patients as inferiors may aggravate conflicts and result in the use of coercive measures (Tingleff et al ).…”

“…Patients live with restrictions and confinement in an unhome‐like atmosphere where they ‘strive to convert the unfamiliar to the familiar and the impersonal to the personal’ (Olausson et al , p. 521). They may feel that they are subjected to humiliating attitudes in a prison‐like culture (Hörberg et al ) and that their opinions and rights are ignored by staff (Askola et al ; Olsson et al ). They might feel burdened by normative expectations of what recovery should look like and pressured to act adherent (Livingston ).…”