What Do Patients Find Restrictive About Forensic Mental Health Services? A Qualitative Study

Tomlin, Jack; Egan, Vincent; Βartlett, Peter; Völlm, Birgit

doi:10.1080/14999013.2019.1623955

Cited by 38 publications

(75 citation statements)

References 52 publications

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“…Qualitative interviews with N = 18 patients in low, medium, and high secure settings in England were conducted and Thematically Analysed to generate the systematized concept (29). Items on the FRQ were derived from interviews.…”

Section: Methodsmentioning

confidence: 99%

“…Items on the FRQ were derived from interviews. Patients described: restrictions on their sense of self given their treatment in forensic hospitals, the limited range and meaningfulness of activities, the prospects of reintegration into the community, the pathologization by staff of patient behaviors, reduced possibilities to exercise choice, and relationships with others inside and outside the hospital as restrictive and restricted (29).…”

Section: Methodsmentioning

confidence: 99%

“…Tomlin et al (29) qualitatively investigated 18 patients’ experiences of restrictiveness in low, medium, and high secure settings. Building on the conceptual work of Sexton (30) we found that patients’ experiences of restrictions could be described as severe and salient .…”

Section: Introductionmentioning

confidence: 99%

“…The definition of restrictiveness used for this project was derived from qualitative interviews conducted with patients reported by Tomlin et al (29). The definition of restrictiveness, taken from the aforementioned study and the wider literature, used to guide the development of the pilot FRQ in the present study was:…”

Section: Introductionmentioning

confidence: 99%

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The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision

et al. 2019

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Introduction: Forensic psychiatric care is often practiced in closed institutions. These highly regulated, secure, and prescriptive environments arguably reduce patient autonomy, self-expression, and personhood. Taken together these settings are restrictive as patients' active participation in clinical, organizational, community, and personal life-worlds are curtailed. The consequences of patients' experiences of restrictiveness have not been explored empirically. This study aimed to develop a psychometrically-valid measure of experiences of restrictiveness. This paper presents the development, validation, and revision of the Forensic Restrictiveness Questionnaire (FRQ). Methods: In total, 235 patients recruited from low, medium, and high secure hospitals across England completed the FRQ. The dimensionality of the 56-item FRQ was tested using Principle Axis Factor Analysis and parallel analysis. Internal consistency was explored with Cronbach's α. Ward climate (EssenCES) and quality of life (FQL-SV) questionnaires were completed by participants as indicators of convergent validity. Exploratory Factor Analysis (EFA) and Cronbach's α guided the removal of items that did not scale adequately. Results: The analysis indicated good psychometric properties. EFA revealed a unidimensional structure, suggesting a single latent factor. Convergent validity was confirmed as the FRQ was significantly negatively correlated with quality of life (Spearman's ρ = −0.72) and ward climate (Spearman's ρ = −0.61). Internal consistency was strong (α = 0.93). Forty-one items were removed from the pilot FRQ. The data indicate that a final 15-item FRQ is a valid and internally reliable measure. Conclusion: The FRQ offers a novel and helpful method for clinicians and researchers to measure and explore forensic patients' experiences of restrictiveness within secure hospitals.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision

et al. 2019

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“…Others have similarly highlighted the tensionand often perceived incompatibilitybetween recovery principles and the nature of secure care (e.g., promoting autonomy and self-determination under conditions of legal coercion [17];). These themes of ambivalence, and the experience of the journey through secure care as being limiting, though necessary, for recovery have been described in the systematic review of forensic user experiences by Shepherd et al [39] and the more recent work of Livingston [24], Aga et al [2] and Tomlin et al [45].…”

Section: Introductionmentioning

confidence: 98%

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

et al. 2020

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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

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A systematic scoping review exploring how people with lived experience have been involved in prison and forensic mental health research

Rutherford,

Bowes,

Cornwell

et al. 2024

Criminal Behav Ment Health

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BackgroundIntroduction of guidance by the National Institute for Health Research has led to an increase in participation by people with ‘lived experience’ of mental health problems. However, some researchers have questioned the extent to which involvement has been meaningful, expressing concerns that involvement is impeded by the structure and culture of academia. A prior review of literature to 2016 provided little evidence of active engagement.AimsTo find out from published literature how patient and public involvement in designing and or conducting research has been used in forensic mental health settings, prisons or probation since the last review period.MethodsA systematic scoping review of research published in academic journals between 2016 and February 2023 was completed using terms for research activity, involvement of people with experience of receiving services and health or justice systems to search three databases: MEDLINE, EMBASE and PsycINFO. We used the Guidance for Reporting Patient and Public Involvement in Research Tool to support data extraction and to summarise our own service user involvement in this study.ResultsFrom 675 unique titles retrieved, 17 were eligible for inclusion, covering 16 unique studies. Most of the included research was by/with people who had prison experience. Only two studies had been conducted by/with people who had experience of secure hospital wards/forensic mental health services. Details of how people with lived experience had contributed to the research were scarce, but in 8 studies they had been involved throughout and included in the authorship group.ConclusionWhilst this review identifies pockets of good practice, meaningful engagement in forensic mental health research seems to remain rare, at least as reported in papers published in academic journals. Further research is required into whether this reflects real limits on inclusion, as we suspect, or such full integration that such reporting is not regarded as necessary or desirable, which we doubt. We urge journal editors to routinely ask authors to include information about how people with lived experience have been involved in any published research and the nature and extent of the influence they had. This may help to develop the evidence base and guard against tokenistic involvement.

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What Do Patients Find Restrictive About Forensic Mental Health Services? A Qualitative Study

Cited by 38 publications

References 52 publications

The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision

The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision

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

A systematic scoping review exploring how people with lived experience have been involved in prison and forensic mental health research

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