Measuring experiences of restrictiveness in forensic psychiatric care: developing a questionnaire

Tomlin, Jack (2021) Measuring experiences of restrictiveness in forensic psychiatric care: developing a questionnaire. PhD thesis, University of Nottingham.

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Forensic psychiatric care is often practiced in closed institutions. These highly regulated, secure and proscriptive environments can reduce autonomy, self-expression and personhood. Taken together these settings can feel restrictive as patients’ active participation in clinical, organizational, community and personal life-worlds are curtailed.

Consequences of restrictive experiences have not been explored empirically. This study aimed to develop a psychometrically-valid measure of experiences of restrictiveness. This thesis presents the conceptualization, development and validation of the Forensic Restrictiveness Questionnaire (FRQ).

This project had a Mixed Methods Methodology. Semi-structured, qualitative interviews were conducted with 18 residents in low, medium and high secure hospitals in England. These explored patients’ experiences of restrictiveness and were analysed thematically. The findings informed the conceptualization of the FRQ items. A pool of 65 items was sent to a panel of five experts in the field of forensic psychiatry for an assessment of face validity.

A revised 58-item FRQ was piloted with N=230 patients. The dimensionality of the FRQ was tested using Exploratory Factor Analysis. Internal consistency was investigated. Ward climate and quality of life questionnaires were completed by participants as indicators of convergent validity. Data were collected on participants’ demographic, clinical and legal profiles to analyse variances in FRQ scores.

The qualitative analysis showed respondents described restrictiveness in five key ways. Patients’ narratives help us understand: 1) the antecedent conditions to restrictive phenomena; 2) restrictive phenomena themselves; 3) how these are enacted in secure settings, 4) how these phenomena were subjectively experienced by residents; and 5) the consequences of these phenomena as expressed by residents.

The quantitative phase indicated that the FRQ has good psychometric properties. Factor Analysis revealed a unidimensional structure, indicating a single latent construct. Convergent validity was confirmed as restrictiveness was significantly negatively correlated with quality of life and ward climate. Internal consistency was demonstrated. Analysis of variance suggested individuals with a diagnosis of personality disorder scored significantly higher on the FRQ than peers with a mental illness diagnosis.

The data indicate that the final 15-item FRQ is a valid and internally reliable unidimensional measure. The correlations between restrictiveness and quality of life and ward atmosphere suggest these constructs are strongly linked. Any interventions concerning quality of care and living conditions must therefore recognise and address experiences of restrictiveness. The FRQ offers a novel and simple measure of an important phenomenon in forensic settings and has clinical and scientific implications.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Bartlett, Peter
Egan, Vincent
Völlm, Birgit
Keywords: Forensic psychiatric care; Restrictiveness; Forensic Restrictiveness Questionnaire; Psychometric test
Subjects: W Medicine and related subjects (NLM Classification) > WM Psychiatry
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 57405
Depositing User: Tomlin, Jack
Date Deposited: 28 Sep 2023 13:58
Last Modified: 28 Sep 2023 13:58

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