‘The illusion of inclusion’: The Paradoxical Experiences of Patients,Carers and Staff Exposed to Violence and Aggression in Scotland and Northern Ireland's Forensic Mental Health In-Patient Services

Abstract

There is a growing body of literature that describes patients, carer and staff experiences of restrictive practices used to manage incidents of violence and aggression in general mental health, however, there is little empirical work exploring the issues in adult forensic mental health in-patient care. This is despite forensic mental health settings reporting higher use of restrictive practices than other mental health settings. This study aimed to explore the experiences of patients, carers and staff exposed to incidents of violence and aggression where restrictive practices were used, and to identify opportunities to enhance the prevention and management of violence and aggression. A purposive sample was recruited from five adult forensic mental health in-patient clinical settings. Semi-structured interviews were conducted with 46 participants; eight patients, three carer co-ordinators and 35 staff. Thematic analysis was used to analyse data, identifying three themes: Tension Between Three Standpoints; The Will To Get It Right; and Outside Looking In. The study identified a chasm exists between policies and practice that espouse collaboration, inclusion and experiences of patients, carers and staff. Opportunities were identified to bridge this chasm such as implementing policy and practice standards that enhance communication and collaboration between patients, carers and staff.