Perceived Institutional Restraint Is Associated With Psychological Distress in Forensic Psychiatric Inpatients

Abstract

Background: Patients in forensic mental health care experience internal and external coercion; the latter comprises different levels of institutional restraint. These restrictions of individual freedom are mainly justified by the safety interests of third parties and are not necessarily in the patients’ best interests. The effects of such a setting on mentally disordered offenders’ psychological state and treatment course are not fully understood. Assessing both patients’ perception of restraint and psychopathological symptoms would allow us to better understand how restraint and psychopathology interact and how they might influence treatment. Methods: In 184 forensic psychiatric inpatients, we assessed perception of institutional restraint with an adapted version of the Measuring the Quality of Prison Life (aMQPL) questionnaire and current psychological state with the Brief Symptom Checklist (BSCL) and Beck Hopelessness Scale (BHS). Results: Perceived institutional restraint (as expressed in the aMPQL subscales Transparency of procedures and decisions , Fairness , and Respect ) was associated with a higher general level of psychological symptoms. Furthermore, patients who perceived a lack of institutional transparency and respect were more likely to have higher scores for hostility, depression, and suicidal ideation. We also found age and sex differences, with higher levels of psychological symptoms in younger and female patients. The diagnosis and duration of detention did not relate to perceived restraint. Discussion: Our results indicate that certain aspects of institutional restraint in long-term forensic inpatient settings correlate with certain psychological symptoms. The observed association might be explained by different kinds of factors: institutional (custodial focus), individual (self-efficacy, diagnosis, and personality), and situational (duration of detention). Although not all of these explanatory factors were addressed by the present study design, forensic mental health professionals should be aware of the relationship between perceived institutional restriction and psychopathology because it might influence treatment course and outcome.

The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision

“…The outcomes of this study add to the findings of Franke et al (31). Measuring perceived restraint with the aMQPL in German secure settings, the authors found that scores were associated with psychological symptoms including hostility, depression, and psychological state more broadly in a negative direction.…”

“…Despite recent qualitative efforts to conceptualize restrictiveness from patients’ perspectives there currently exists no valid and reliable measure that has been developed from interviews with patients and psychometrically validated. The closest is a version of the Measuring Quality of Prison Life Questionnaire adapted for forensic psychiatric settings (aMQPL) (31). The authors combined the domains “Transparency of procedures and decisions,” ”Fairness,” and ”Respect” to measure perceived institutional restraint alongside psychopathological symptoms and suicidal ideation across 130 patients in German forensic hospitals.…”

Perceptions of Restrictiveness in Forensic Mental Health: Do Demographic, Clinical, and Legal Characteristics Matter?

“…However, the study of perceived restraint by Franke et al (2019) found no relationship with diagnosis. The authors hypothesized that the externally imposed constraints of secure care manifest in different negative adjustments made by patients.…”

“…Although we found no relationship between experiences of restrictiveness (similar to containments in Bowers’s terminology) and age, there was support for an association with diagnoses. Future studies serious in discerning differences across individuals’ experiences of restrictiveness should measure the individual characteristics identified by Bowers (2014) and Franke et al (2019).…”

“…Reporting on the validation of the Forensic Restrictiveness Questionnaire (FRQ) conducted within this study but reported elsewhere, we found that perceptions of restrictiveness measured with the FRQ were strongly negatively correlated with quality of life and ward atmosphere (Tomlin, Völlm et al, 2019). Franke and colleagues (2019) also explored these experiences quantitatively. They found that perceptions of the concept of restraint as measured with the adapted-Measuring Quality of Prison Life Questionnaire were associated with psychological distress, specifically hostility, depression, global psychological state, and suicidal ideation.…”