Though some empirical and anecdotal accounts can be located in the extant literature, it remains the case that little is known about how secluded/restrained (S/R) patients perceive their overall treatment. The purpose of this study was to explore patients' perceptions of their hospital treatment measured after S/R. The data were collected with a Secluded and Restrained Patients' Perceptions of their Treatment (S/R-PPT) questionnaire from S/R patients aged 18-65 years. Ninety completed questionnaires were analysed. Patients perceived that they received enough attention from staff, and they were able to voice their opinions, but their opinions were not taken into account. Patients denied the necessity and beneficence of S/R. Women and older patients were more critical than men and younger patients regarding the use of restrictions. There were also statistically-significant differences in responses among patients at different hospitals. It is concluded that patients' opinions need more attention in treatment decisions. To achieve this, psychiatric treatment needs genuine dialogue between patients and staff, and individual care should have alternatives and no routine decisions. Therefore, the treatment culture must improve towards involving patients in treatment planning, and giving them a say when S/R is considered.

The findings of the present study should direct the forensic psychiatric personnel's attention to the notion that forensic psychiatric patients' experiences of their treatment can improve the quality of patient-centered care and reduce bureaucracy.

This study aims to describe the views of forensic psychiatric patients' parents, and especially how they feel about the patient's offense. The data analyzed was collected by interviews with forensic psychiatric patients' parents and analyzed by inductive content analysis. The findings suggest that the offense committed has a significant effect on the lives of parents of forensic psychiatric patients and in many ways these people felt like a marginalized group even though they were frequently a major resource for their child who had been taken into forensic psychiatric care. The parents of a forensic psychiatric patient have a prominent role in the life of the patient and this role and the parents' coping should also be supported by the forensic psychiatric treatment system.

BackgroundDespite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use. Studying perceptions among patients who have been secluded or physically restrained during their hospital stay is challenging. We sought to review the methodological and ethical challenges in qualitative and quantitative studies aiming to describe patients’ perceptions of coercive measures, especially seclusion and physical restraints during their hospital stay.MethodsSystematic mixed studies review was the study method. Studies reporting patients’ perceptions of coercive measures, especially seclusion and physical restraints during hospital stay were included. Methodological issues such as study design, data collection and recruitment process, participants, sampling, patient refusal or non-participation, and ethical issues such as informed consent process, and approval were synthesized systematically. Electronic searches of CINALH, MEDLINE, PsychINFO and The Cochrane Library (1976-2012) were carried out.ResultsOut of 846 initial citations, 32 studies were included, 14 qualitative and 18 quantitative studies. A variety of methodological approaches were used, although descriptive and explorative designs were used in most cases. Data were mainly collected in qualitative studies by interviews (n = 13) or in quantitative studies by self-report questionnaires (n = 12). The recruitment process was explained in 59% (n = 19) of the studies. In most cases convenience sampling was used, yet five studies used randomization. Patient’s refusal or non-participation was reported in 37% (n = 11) of studies. Of all studies, 56% (n = 18) had reported undergone an ethical review process in an official board or committee. Respondents were informed and consent was requested in 69% studies (n = 22).ConclusionsThe use of different study designs made comparison methodologically challenging. The timing of data collection (considering bias and confounding factors) and the reasons for non-participation of eligible participants are likewise methodological challenges, e.g. recommended flow charts could aid the information. Other challenges identified were the recruitment of large and representative samples. Ethical challenges included requesting participants’ informed consent and respecting ethical procedures.

BackgroundIn Finland major effort has been invested in reducing the use of coercion in psychiatric treatment, and the goal is to diminish the use of coercion by 40% by 2015. Improving patients’ quality of life (QoL) has gained prominence in psychiatric treatment during the past decade. Numerous studies have shown that most secluded or restrained patients (S/R patients) would prefer not to have had this experience. Experience of S/R could affect negatively patients’ QoL, but empirical data on this issue are lacking.AimThe study aimed to explore the effect of experienced S/R on the subjective QoL of psychiatric in-patients.MethodThis study explored subjective QoL of the S/R patients. At discharge, S/R patients completed the Short Form of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF).ResultsWe found that S/R patients’ (n = 36) subjective QoL was significantly better than that of non-S/R patients’ (n = 228). Most non-S/R patients were diagnosed with mood disorders (mostly depression). Most of S/R patients were diagnosed with schizophrenia, schizotypal and delusional disorders. The mean duration of S/R was 2.3 days, median was one day and mean length of the hospitalization after S/R episode was 2.5 months.ConclusionOur cross-sectional findings suggest that S/R does not considerably influence patients’ QoL or that the influence is short-lived. Because baseline QoL was not measured this remains uncertain. There are also many other factors, such as negative mood, which decrease the patients’ QoL ratings. These factors may either mask the influence of S/R on QoL or modify the experience of QoL to such an extent that no independent association can be found at the time of discharge.

Aim:  To develop a standardized self‐reporting questionnaire to evaluate patients' perceptions of their overall treatment in specific relation to the use of seclusion and/or restraint (SR) measures as part of the treatment program. Methods:  A 17‐item self‐rating questionnaire was given to 56 patients with experience of SR‐related treatment to develop a new scale, the Secluded/Restrained Patients' Perceptions of their Treatment (SR‐PPT). Concurrent validity was examined against the Client Satisfaction Questionnaire‐8 Japanese Version (CSQ‐8J). In addition, Patient burden induced by answering the SR‐PPT was evaluated. Results:  On factor analysis, two factors named as Cooperation with Staff (nine items) and Perceptions of SR (two items) were derived. Cronbach's coefficient alphas were 0.928 and 0.887, and correlation coefficients against the CSQ‐8J were 0.838 and 0.609, respectively. Answering the SR‐PPT was found to induce little burden on the patients. Conclusion:  Adequate internal consistency and concurrent validity of the final version of the SR‐PPT, which consists of 11 items, indicate that it is acceptable as a measurement scale. Use of this questionnaire will add the patient's view to the assessment of overall treatment involving SR.

This study aims to describe forensic psychiatric patients' experiences of their offense and its meaning for their lives, and to increase the understanding of the meaning of the offense in the eyes of the patient. The data analyzed was collected by interviews with forensic psychiatric patients and analyzed by narrative analysis. The findings suggest that forensic psychiatric patients have different types of stories describing the offense and its meaning in their lives. Illness narratives can be utilized therapeutically because they may construct patients' identity, experiences, and their situation as people with an illness seek explanations and meanings for their plight.

Coercive situations are complicated and stressful for both the one being forced as well as the one forcing the other. Patients' experiences of coercion have been studied since the end of the 1970s, and interest in this theme has increased since about 2000. It seems that involuntary treatment as a general concept is more accepted than individual, specific coercive measures, such as forced medication, seclusion or restraint, which patients usually deem unnecessary. Patients' views on seclusion and restraint have been mostly but not always negative. For instance, patients have expressed seclusion-or restraint-related feelings of safety and security, protection, trust, helpfulness and a decrease of stimulation. Moreover, perceptions vary according to, for example, patients' age and gender and their adaptation to the illness and treatment system. The importance of patients' perspective and service user involvement in the development of services has been officially recognised. Indeed, taking patients' experience into proper consideration is a matter of the services' quality. In this chapter, we also discuss these future challenges.