Patient participation in a forensic psychiatric unit: an action research study

Background: The Danish health care system has been entrusted with implementing patient participation in all
sectors of the system, including in psychiatric units. The implementation of patient participation is expected
to lead to increased patient satisfaction and safety, improved experienced quality of life for the patients, better
treatment results, a more efficient use of resources, and that patients fare better after discharge. However, it
has proven difficult to implement patient participation in forensic psychiatric units. First, the idea of patient
participation contains a demand on patients of exercising self-restraint; something which is difficult to expect
of patients in a forensic psychiatric unit. Second, the idea of patient participation is in opposition to three
dominant ways of thinking within the field of mental health care, namely neoliberalism, a narrow conception
of what constitutes scientific knowledge, and medical paternalism. Despite these barriers, studies show that
nurses are motivated to work with patient participation.
Aim: The aim of the first phase of the Ph.D. study is to gain insight into how forensic health care professionals
and inpatients view patient participation in everyday clinical practice.
Method: To explore how forensic healthcare professionals, inpatients and relatives view patient participation
in everyday clinical practice, the study uses participant observation and focus group interviews.
Results and Discussion: The results of the participant observation presented in vignettes illustrating situations
and dilemmas related to patient participation in the unit. In parallel, focus group interviews are conducted
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with selected participants. The data from the participant observation and the focus group interviews are analyzed thematically. The emerging themes will be used to define focal points in the workshops in phase two and
as a baseline for the evaluation in phase three of the Ph.D. study.