Offense-Related Issues in Forensic Psychiatric Treatment: A Thematic Analysis

Abstract

Characteristics unique to forensic psychiatric treatment include coming to terms with the offenses committed, the long duration of treatment and the assessment of the risk of repeat offending. This study describes the views of both patients and staff on the significance of the patient's offense as a part of forensic psychiatric rehabilitation. Eight forensic psychiatric patients and eight forensic psychiatric nurses from two forensic psychiatric hospitals in Finland participated in this study. Data were gathered by means of thematic interview and analyzed by means of thematic analysis. The findings suggest that patients and professionals alike concur that ascertaining the factors with a bearing on the offense, and working through the offense and the factors leading up to it, constitute an essential aspect of forensic treatment. This, in turn, has a bearing on the planning and administration of a treatment plan consisting of both medical and psychosocial support and interventions intended to enable patients to live independent, fulfilling lives, thus reducing the likelihood of reoffending. The findings of this study can be used as part of the development of international, standardized treatment models for clinical forensic psychiatric practices.

Factors Affecting Treatment Regress and Progress in Forensic Psychiatry: A Thematic Analysis

“…As elsewhere ( 8 , 62 ), through a process of transinstitutionalization, supported housing provision in Finland has increased ( 63 ). Despite this, the continued trend of deinstitutionalization combined with changes in mental healthcare funding and associated budget cuts ( 7 ) have resulted in an increase in social marginalization, untreated substance abuse, and psychiatric morbidity ( 64 , 65 ). Similarly, De Page and Titeca ( 66 ) concluded in their analysis of 10 years' routine data collection that the severity in terms of risk, psychopathic personality traits, and lack of cognitive and functional capacities of forensic psychiatric patients had increased.…”

Offender Recovery. Forensic Patient Perspectives on Long-Term Personal Recovery Processes

“…A therapeutic approach to a patient’s offence demands dedicated and stage-specific interventions from the mental health professional as well as courage and willingness to reflect on one’s own prior understanding and emotional reactions to severe offences [ 44 ]. The process of offender recovery is twofold: to address the index crime and circumstances which led to it, as well as addressing and reducing the risk of re-offending [ 45 ]. Working with offender recovery seems crucial in order to support identity-building and new understandings and meanings of life, and to overcome consequences of severe mental illness and committing crimes [ 10 ].…”

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“…Positive patient experiences will yield ideal patient outcomes, such as decreased relapse into severe mental illness and decreased risk of reoffending. Throughout their inpatient stay, patient experience leading to positive patient outcomes can be optimized when treatment focuses on working through the factors that led to the offense while emphasizing the protective factors of the patient [6]. Patients are more likely to engage in their treatment and participate in treatment planning when nursing personnel approach them with compassionate care and take measures to provide as much autonomy as possible in the secure psychiatric forensic institution [7].…”

“…Patients are more likely to engage in their treatment and participate in treatment planning when nursing personnel approach them with compassionate care and take measures to provide as much autonomy as possible in the secure psychiatric forensic institution [7]. Furthermore, comprehensive aftercare and treatment guidelines for discharge from the psychiatric forensic setting help to inform the best patient outcomes by decreasing the risk of reoffending [6]. The recommendations inferred from a review of the literature provide psychiatric forensic nurses with tactics to enhance patient experience while in a particularly vulnerable setting for the patient and the nurse.…”

“…Interviews with forensic psychiatric patients and forensic psychiatric nurses shed light on the significance the offending crime by the psychiatric forensic patient has on the rehabilitation process in a psychiatric forensic hospital [6]. Thematic analysis of interviews demonstrates that the committed offense has an important bearing on the treatment and rehabilitation process of the psychiatric forensic patient [6].…”