A Focused Ethnography of Researchers Navigating Power Dynamics When Implementing Patient-Oriented Research Practices in a Forensic Mental Health Setting

Abstract

This ethnographic study explores how a research team navigated power dynamics while developing patient-oriented research practices in a high-secure forensic mental health care setting. Data were collected through team meetings, interviews, and field notes. The study explored how power was understood and addressed at individual, interpersonal, and structural levels. The three themes and six subthemes focused on the importance of acknowledging power within the system, power given to the project through community support, and power held by researchers. Researchers learned to navigate strict policies, procedures, and practices within the forensic environment, focusing on building trust with staff while ensuring patient autonomy and engagement. Equitable communication, particularly with patients, was critical in garnering support for patient-oriented research, often requiring the use of accessible language. Lastly, reflexivity allowed the research team to critically reflect on their biases and positionalities, fostering power-balanced relationships essential for authentic engagement. Findings suggest that addressing power imbalances early and often, and building on the support of staff champions, are key considerations for conducting patient-oriented research in forensic mental health settings.