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

Tomlin, Jack; Bartlett, Peter; Völlm, Birgit

Authors

Jack Tomlin

PETER BARTLETT peter.bartlett@nottingham.ac.uk
Nottingham Healthcare Nhs Trust Professor of Mental Health Law

Birgit Völlm



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.

Citation

Tomlin, J., Bartlett, P., & Völlm, B. (2018). Experiences of restrictiveness in forensic psychiatric care: systematic review and concept analysis. International Journal of Law and Psychiatry, 57, https://doi.org/10.1016/j.ijlp.2017.12.006

Journal Article Type Article
Acceptance Date Jan 18, 2018
Online Publication Date Jan 30, 2018
Publication Date Mar 30, 2018
Deposit Date Feb 1, 2018
Publicly Available Date Jul 31, 2019
Journal International Journal of Law and Psychiatry
Print ISSN 0160-2527
Electronic ISSN 0160-2527
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 57
DOI https://doi.org/10.1016/j.ijlp.2017.12.006
Keywords Forensic; Secure; Mental health; Restrictiveness; Autonomy
Public URL http://eprints.nottingham.ac.uk/id/eprint/49490
Publisher URL https://www.sciencedirect.com/science/article/pii/S0160252717301802
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0





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