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

Tomlin, Jack and Bartlett, Peter and Völlm, Birgit (2018) Experiences of restrictiveness in forensic psychiatric care: systematic review and concept analysis. International Journal of Law and Psychiatry, 57 . pp. 31-41. ISSN 0160-2527

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Abstract

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.

Item Type: Article
Keywords: Forensic; Secure; Mental health; Restrictiveness; Autonomy
Schools/Departments: University of Nottingham, UK > Faculty of Social Sciences > School of Law
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Psychiatry and Applied Psychology
Identification Number: https://doi.org/10.1016/j.ijlp.2017.12.006
Depositing User: Eprints, Support
Date Deposited: 01 Feb 2018 15:52
Last Modified: 01 Feb 2018 16:08
URI: http://eprints.nottingham.ac.uk/id/eprint/49490

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