Caregiver perspectives on patient capacities and institutional pathways to person centered forensic psychiatric care

El-Alti, Leila; Sandman, Lars; Munthe, Christian

Abstract

The ethical discourse surrounding patients’ agential capacities, vis-à-vis their active participation in shared decision-making (SDM) in forensic psychiatric (FP) contexts, is an unexplored area of inquiry. The aim of this paper is to explore caregivers’ perceptions of patient agential capacities and institutional pathways and barriers to person centered care (PCC) in the context of FP. Following an exploratory qualitative design, we conducted eight semi-structured interviews with hands-on caregivers at an in-patient FP facility in Sweden. A deductive framework method of analysis was employed, and four themes emerged: “Fundamental Variability in Patient Capacity”, “Patient Participation: Narration or Compliance?”, “Antagonism Rooted in Power Struggles”, and “System Structure Thwarts Patient Release”. While the results generally paint a bleak picture for the possibility of a person-centered FP care, we describe a constrained version of PCC with high-level SDM dynamics which promotes a certain degree of patient empowerment while allowing care strategies, within set restrictions, to promote patient adherence and treatment progress.

Citation

El-Alti, L., Sandman, L., & Munthe, C. (2022). Caregiver perspectives on patient capacities and institutional pathways to person centered forensic psychiatric care. PLOS ONE, 17(9), Article e0275205. https://doi.org/10.1371/journal.pone.0275205

• Journal Article Type: Article
• Acceptance Date: Sep 13, 2022
• Online Publication Date: Sep 29, 2022
• Publication Date: 2022
• Deposit Date: Oct 5, 2022
• Publicly Available Date: Oct 5, 2022
• Journal: PLOS ONE
• Print ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Issue: 9
• Article Number: e0275205
• DOI: https://doi.org/10.1371/journal.pone.0275205
• Public URL: http://researchrepository.napier.ac.uk/Output/2926530