What Do Patients Find Restrictive About Forensic Mental Health Services? A Qualitative Study

Abstract

Forensic care settings are often isolated spaces with high levels of security. Where these settings are overly restrictive, this can affect recovery, autonomy and the therapeutic milieu. It is not clear what phenomena patients themselves identify as restrictive and how, subjectively, they experience these. Semi-structured interviews were conducted with 18 patients in secure hospitals in England. Respondents included male and female patients with mental illness or personality disorders on both civil and criminal detentions. The results suggest a model of restrictiveness consisting of five themes: (1) the antecedent conditions to restrictive phenomena; (2) restrictive phenomena themselves; (3) how these are enacted, (4) how these phenomena were subjectively experienced by patients; and (5) the consequences of these phenomena as expressed by patients. Restrictiveness understood in this way is broader than “least restrictive practices” typically understood as restraint, seclusion and forced medication. Respondents’ comments encourage us to rethink the unintended effects of placing individuals within secure hospitals.