The Concept of Patient Participation in Forensic Psychiatric Care

Abstract

The importance of patient participation is advocated in medical treatment and nursing care and has been linked to increased quality of care, increased patient satisfaction, and treatment adherence. Still, patients in forensic psychiatric care often report being unhappy with their experienced level of participation. The concept of patient participation is complex and has several definitions, thus it is important to investigate it from different perspectives in different contexts. The aim of this study was to describe patients' perceptions of the concept of patient participation in forensic psychiatric care. A qualitative design with a phenomenographic approach was used, and interviews with 19 participants in a Swedish setting were completed. The participants described the concept of patient participation in forensic psychiatric care as follows: influence, to have good communication and to be involved; confidence, to have mutual trust and to trust the care; and own responsibility, to participate in activities and to take the initiative. On the basis of the results of this study, improved patient participation in forensic psychiatric care may be achieved with active communication, by building up and maintaining trust for professional competence and by encouraging patients' own responsibility. It is important that knowledge about patients' views of the concept of patient participation is included in the planning and improvement of forensic care.

Residents’ Perceptions of Quality in Supported Housing for People with Psychiatric Disabilities

“…An increased focus on recovery in the staff training at SH units could help to improve the levels of participation and thus quality of care. From a forensic psychiatric care context, Selvin, Almqvist, Kjellin, and Schr€ oder (2016) maintain that patient participation can be improved by active communication and the encouragement of patients taking responsibility, which is also applicable in a supported housing context.…”

‘I know what I need to recover’: Patients’ experiences and perceptions of forensic psychiatric inpatient care

“…A dominant focus on safety and risk management in psychiatric care might impede individualized, flexible, and recovery-oriented approaches to care (Higgins et al 2016;Morrissey et al 2018;Slemon et al 2017). As forensic psychiatric care means caring for patients with severe mental illness while protecting society from further criminal acts, there is an inherent risk that nursing might be overshadowed by ideas of discipline and corrective approaches (H€ orberg & Dahlberg 2015;Selvin et al 2016). As described by Higgins et al (2016), a broader understanding of risk underlines that risks are not necessarily dramatic and acute, and that they may be both positive and negative.…”

“…Conceptualizations of psychiatric care as person‐centred (Gabrielsson et al ) and recovery‐oriented (Le Boutillier et al ) align with growing expectations of user involvement in health care, reflecting both an interest in empowering citizens and containing costs (Dent & Pahor ). A challenge for forensic psychiatric care is to create a caring climate despite patients being cared for against their will (Selvin et al ). The relationship between person‐centred and safety‐focused approaches to care has attracted much attention in psychiatric inpatient care research (e.g.…”

“…Relationships and social activities can help prevent loneliness and contribute to patients' well-being (Olausson et al 2019). For patients to feel involved, they must be invited and heard in discussions and dialogue; rather than just receiving information, they need to be engaged in their own care through mutual trust (Livingston et al 2013;Selvin et al 2016). Patients may experience that coercive measures are used in their best interest, to prevent them from doing things they would regret (Holmes et al 2015;Tingleff et al 2019).…”

An Interview Study of Professional Carers’ Experiences of Supporting Patient Participation in a Maximum Security Forensic Psychiatric Setting

“…A qualitative study from a patient perspective conducted in two Swedish forensic psychiatric clinics indicated that participation encompassed factors such as influence, confidence, and responsibility. The study emphasised the importance of being involved as a patient and that good communication between caregiver and patient is fundamental to impact care and exert influence (Selvin, Almqvist, Kjellin, & Schr€ oder, 2016). Another study showed that patients' needs of being accepted and belonging were critical for their ability to be themselves (Aga, Vander Laenen, Vandevelde, Vermeersch, & Vanderplasschen, 2017).…”