Project: Patient participation in forensic psychiatric care (USEFOR)

More about the project

The USEFOR project focuses on participation in forensic psychiatric contexts. According to Swedish health legislation (Patient Act §5), care shall promote patient participation and be based on the patient's will. Forensic psychiatric care is controlled by the same laws that control all healthcare, but has additional laws that control the compulsory treatment. The latter and patient participation are the antithesis of each other, thus leading to different and still unexplored challenges in forensic psychiatric care.

There is a great deal of support for the fact that patient participation is in general something good that benefits the patient. The SBU report 287/2018 states, in a systematic review of Swedish qualitative studies regarding patients' experience of forensic psychiatric care, that patients experience vulnerability and a lack of participation and autonomy. However, research in this area is very scarce.

How patient participation is understood in an environment where the patients the treatment can include coercive measures is relevant, especially as a growing number of regional health authorities adopt the concept of person-centered care where participation in the form of shared decision-making is a core trait.

The first study in the project is a phenomenological interview study focusing on how carers in forensic psychiatric maximum security environments work to support patients' participation. The results show that the concept is complex and that there is an ambiguity concerning the content of the concept of participation. Carers are expected to support participation while at the same time maintaining safety and routines, which can be understood as part of what is termed the "dual role dilemma".

The second study will follow from the first to gain a broader perspective of these and previous results by interviewing patients, who will be asked about how they experience opportunities for participation in the forensic psychiatric maximum security environment. The study advances the current research front in the field as it tries to understand how participation can be possible and the consequences that result from this in a forensic psychiatric care setting, related to the development of person-centered care.

The third study will examine how patients experience their participation in the proceedings of the administrative court. A court hearing is held every six months to determine whether the compulsory care order is to be extended. This forum is particularly interesting in relation to the concept of participation.

The fourth study will examine how care relationships and quality of care correlate with the levels of participation as perceived by patients and staff. This will be performed by using the Verbal and Social Interaction questionnaire (VSI) and the Quality in Psychiatric Care – Forensic Inpatient (QPC-FIP).

The project is part of the research in the research groups Hälsa, vårdande och lärande på livsvärldsteoretisk grund (HVL) and Social-, kommunal-, allmän- och rättspsykiatrisk vård (SKARP)