Experiences of restrictiveness in forensic psychiatric care: Systematic review and concept analysis

By JackTomlin, PeterBartlett & BirgitVöllm

Mentally disordered offenders may be sent to secure psychiatric hospitals. These settings can resemble carceral spaces, employing high levels of security restricting resident autonomy, expression and social interaction. However, research exploring the restrictiveness of forensic settings is sparse. A systematic review was therefore undertaken to conceptualize this restrictiveness. Eight databases were searched for papers that address restrictive elements of secure forensic care in a non-cursory way. Fifty sources (empirical articles and policy documents) were included and subject to thematic analysis to identify 1) antecedent conditions to, 2) characteristic attributes, 3) consequences and 4) ‘deviant’ cases of the developing concept.

The restrictiveness of forensic care was experienced across three levels: individual, institutional and systemic. Restrictiveness was subjective and included such disparate elements as limited leave and grounds access, ownership of personal belongings and staff attitudes. The manner and extent to which these are experienced as restrictive was influenced by two antecedent conditions; whether the purpose of forensic care was to be more caring or custodial and the extent to which residents were perceived to be risky. We argue that there must be a reflexivity from stakeholders between the level of restrictiveness needed to safely provide care in a therapeutic milieu and enable the maximum amount of resident autonomy.

For full text article, please click here.

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Living in a forensic-psychiatric institution as a life perspective? – Quality of life and needs of long-term forensic psychiatric patients

Written by: Martin Feißt, Sabrina Wiecek, Bernd Dimmek and Inga Markiewicz

Across Europe an increase in the duration of the placement of patients in theforensic hospital can be observedas well as in GermanyThis development makes it imperative to deal with this topic and the related legalsocial and ethical issues. A cooperation between the LWL Academy of Forensic Psychiatrythe University of Witten/Herdecke and the Institute for Psychiatry and Neurology in Warschau, Poland,  an educational research project on quality of life of long-term patients in forensic hospital” has been taking place (up to and including the winter semester 2015/16).

The aim of this project is to attain a better understanding of the needs of patients on the basis of qualitative interviews with patients and staffwhich may be important for the design of the accommodation and for therapeutic purposes.

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Client Service Centre – Ex-User Involvement at the “Woenselse Poort” in the Netherlands

The process of recovery is often more difficult for forensic psychiatric clients than for people who are treated within the ‘regular’ mental healthcare system. Within a secure facility such as De Woenselse Poort (‘the Woensel Gateway’), the Client Service Centre was set up with a view to offering clients more support and opportunities. Very soon after admission, the Client Service Centre can be called upon to help clients to help themselves and develop their skills and acquire general knowledge, separate from their treatment program and hospital ward. In this way, the Client Service Centre tries to assist clients in their recovery process.

The complete article – written by Toon Walravens – about the Client Service Centre and ex-User Involvement can be read here.

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Long-Term Suicide Risk in Forensic Psychiatric Patients

Based on the article Long-Term Suicide Risk in Forensic Psychiatric Patients by Clarke, M., Davies, S., Clive, H. & Duggan, C. (2011) in Archives of Suicide Research, 15: 1, 16 — 28

It is often said that psychiatric patients are a greater risk to themselves than others; while this may be true for general samples, the risk that patient treated in Forensic Psychiatric Units present to themselves, rather than to others, which by the nature of the sample is high, had not been a focus for study. Clarke et al. (2011) investigated the long-term suicide risk in forensic psychiatric patients. They performed a retrospective study, which considered the mortality outcomes of a cohort of 595 former patients of a medium secure unit in Leicester, England. Patients were admitted during the 20-year period between 1983 and 2003. The study found an increased risk of mortality in former forensic patients, from all causes, and particularly from suicide.

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