Personal recovery and its challenges in forensic mental health: systematic review and thematic synthesis of the qualitative literature

Abstract

Background There has been a call for a framework to guide recovery-oriented practices in forensic mental health services. Aims This study aims to examine personal recovery and its challenges in forensic mental health settings in relation to the established framework for personal recovery in mental illness: connectedness, hope, identity, meaning and empowerment (CHIME). Method This study is an updated and expanded systematic review and thematic synthesis of the qualitative literature. A systematic search of six electronic databases (Web of Science, Medline, PsycINFO, CINAHL, EMBASE and SocIndex) was carried out in January 2019, using the terms [Recover*] AND [Forensic OR Secure] AND [Patient* OR Offend* OR Service User*]. Only studies that included service user's own perceptions and were published from 2014 onward were included in the review. Data were examined with thematic synthesis and subsequently analysed in relation to the CHIME framework. Results Twenty-one studies were included in the review. Findings suggest that some adjustments to the original CHIME framework are needed for it to be more relevant to forensic populations, and that an additional recovery process regarding feeling safe and being secure (safety and security) could be added to CHIME, providing the CHIME-Secure framework (CHIME-S). Specific challenges and barriers for forensic recovery were identified and found to represent the opposite of the recovery processes defined by CHIME (e.g. hopelessness). Conclusions We present the CHIME-S as a framework for the personal recovery processes of forensic mental health service users. The CHIME-S may guide the recovery-oriented work of forensic mental health services.

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

“…Similarly, empathy, coping, work, leisure activities, good financial management, motivation for treatment, positive attitudes to authority, life goals, taking medication, and positive social networks all conveyed protective effects and reduced the risk of violence, but only when accompanied by good self-control. Indeed, as Simpson and Penney ( 54 ) and others ( 55 ) point out, bridging the concepts of security and therapy is perhaps most crucial to the recovery of the forensic patient.…”

A review and comparative analysis of the risk-needs-responsivity, good lives, and recovery models in forensic psychiatric treatment

“…The autonomy of the individual, which is a fundamental characteristic of successful personal recovery, is (or is understood to be) limited in FMH services. Several attempts have been made to repurpose such frameworks for the specific characteristics of FMH, such as the one recently proposed by Senneseth et al ( 30 ), which will be described in the next section.…”

“…In secure settings, the RM has been often investigated in qualitative studies. A recent systematic review included 19 such studies and two former systematic reviews on forensic mental health service users’ perspectives on recovery ( 30 ). The authors found support for the five recovery processes of the above-mentioned CHIME framework.…”

“…The authors found support for the five recovery processes of the above-mentioned CHIME framework. However, they added a sixth process, which they called safety and security , i.e., the need to feel “protected from hostile people and environments and the active practice of self-management of risk” ( 30 ). In addition, they identified challenges and barriers to personal recovery in forensic mental health services.…”

Personal recovery in forensic institutions as a political process: the significance of frameworks for clinical practice

“…2 Leamy et al 3 operationalised and defined a conceptual framework of recovery that has acted as a benchmark for the exploration that followed in various institutions and fields of practice. In this issue of BJPsych Open , Senneseth et al 4 continue in this tradition by exploring the workability of the CHIME framework defined by Leamy et al within forensic mental health settings. Their review neatly and clearly explores and summarises the pathways and barriers in relation to each of the five core recovery concepts of CHIME – connectedness, hope, identity, meaning and empowerment – experienced by patients accessing forensic mental healthcare.…”