Factors Influencing Patient Participation in Inpatient Forensic Psychiatric Care - A Mixed-Method Systematic Review

In this systematic review, we aimed to identify facilitating or hindering factors for patient participation in inpatient forensic psychiatric care. Ten studies, qualitative (n = 8), quantitative (n = 1), and mixed method (n = 1), were included. Findings were categorized using the European standard for minimum requirements for patient involvement in health care. We identified a supportive care relationship as an essential prerequisite for participation. This includes ensuring that patients feel trust, included in discussions, and seen as a person, beyond the index crime but with an understanding for their psychiatric illness. Patients' transition phases through their illness and the forensic psychiatric care system initially appeared to negatively influence patient participation. However, as they approached their release from forensic psychiatric care, a positive shift in their willingness to participate in their care became evident. Factors such as stigmatization, safeguarding one's own security, and the coercive forensic psychiatric care environment, were identified as factors significantly hindering patient participation. Moreover, patients perceived participation in care planning as confusing, as they felt excluded from influencing any care-related decisions. Staff, in contrast, were restrictive with information regarding patient care, which had additional negative effects on patients' understanding of their situation. We conclude that future research is needed to examine clinical routines and strategies that may improve patient participation. Furthermore, more quantitative research is needed to examine the challenges for this specific patient population and environment. Future interventions should focus on improving the quality of relationships, information-sharing, and patient involvement in key elements of forensic psychiatric care.