The meanings of place and space in forensic psychiatric care – A qualitative study reflecting patients’ point of view

Abstract

The outcome of care for patients sentenced to forensic psychiatric care is of importance not only for the patient but also for society, in preventing new crimes. In recent years, a person‐centered perspective is influencing the care, recognizing the design of the physical environment as a therapeutic resource. To capture the complexity of patients’ experience of the physical environment, a qualitative approach is needed. The aim of this study was to investigate the meanings of the patient room as a place and space in forensic psychiatric in‐patient care from the patients’ perspective. An explorative qualitative design was chosen, data were collected by photovoice; a combination of photographs, taken by the patients, followed by interviews. Eleven (N = 11) patients were interviewed. The interviews were analysed by a thematic analysis method. Four themes emerged from the data revealing the meanings of the patient room as a place and space: (i) striving towards normality; (ii) being anchored and protected; (iii) being at‐home and homeness; and (iv) being in communion and meaningfulness. The findings show that the physical environment has a say in patients’ basic needs and a role in maintaining normality. Substandard reveals a lack of respect and dignity towards this patient group. Involving patients in the design process of new facilities can be a way to make progress.

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

“…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 ). Furthermore, they might experience feeling depersonalized (Olausson et al ),dehumanized, and monstrous (Møllerhøj & Stølan ) and harbour a constant desire to escape care that they perceive as punishment or restriction involving uncertainty and unreliability (Hörberg et al ). Patients who are parents may lack support from staff in dealing with the stigma of mental illness that poses a barrier to keeping in contact with their children (Parrott et al ).…”

“…The small pockets of good care occur when staff dare to be themselves, are able to see the patient in the context of his or her life world, and to provide emotional support through interpersonal relationships (Hörberg et al ). Relationships and social activities can help prevent loneliness and contribute to patients’ well‐being (Olausson et al ). For patients to feel involved, they must be invited and heard in discussions and dialogue; rather than just receiving information, they need to be engaged in their own care through mutual trust (Livingston et al ; Selvin et al ).…”

Controlling emotions—nurses’ lived experiences caring for patients in forensic psychiatry

“…This is because nurses do not see the patient as dynamic individuals; rather, they are viewed as or she is but static, one-dimensional people (Lilja & Hellzén, 2007). According to Olausson et al (2019), a relationship can be a lifeline-saving the patient from loneliness and contributing to their wellbeing. If patients sense that nurses are attempting to empathize with them, it may foster trust and open the lines of communication.…”

“…According to Vorstenbosch, Bouman, Braun, and Bulten (2014) one third of the offenders who commit these acts have a severe mental illness, if a diagnosis is established after a forensic psychiatric examination, the person will likely be admitted to forensic psychiatric care, which is characterized by long hospital stays. In an environment that is characterized by security (Doyle, Quayle, & Newman, 2017) and can be experienced as restricted (Olausson, Danielson, Berglund Johansson, & Wijk, 2019). The caring relationship is central to forensic nursing (Encinares, McMaster, & McNamee, 2005) and a major part of care consists of nurses' encounters with the patient (Tenkanen et al, 2016), and Rask and Brunt (2006) notes that nurses should promote conversations with patients.…”