Patient participation and quality of forensic psychiatric care

The aims of this thesis were to investigate the quality of forensic psychiatric care, to describe the concept of patient participation from a patient and health care professional perspective, and to initiate the development of an instrument for measuring participation from a patient perspective.Forensic psychiatric care is a specialized form of care where patients who have committed a crime that would normally have led to prison, instead are treated for a serious mental disorder. In study I patients’ and professionals’ experiences of quality of forensic psychiatric care were measured, and one of the findings was that questions regarding participation was rated as low by both patients and staff. In Study II the patients perceived the concept of patient participation as: Influence by having good communication and being involved; Confidence by mutual trust and trusting the care; Own responsibility by taking part in activities and to take own initiative. The findings in Study III highlights the importance as a professional to create prerequisites for patient participation by using good communication and inviting the patient to be involved, whilst at the same time adjusting for the forensic psychiatric conditions by taking professional responsibility and assessing the patients’ current capacity. If used correctly, patient participation encourages the patient to become more independent. In study IV, the initial development of an instrument for measuring participation in forensic care from a patient perspective was described. The findings contribute with important knowledge that can encourage reflection and accordingly help mental health professionals and decision makers to create an environment that promotes patient participation in forensic psychiatric care. Further research should investigate the longterm effects of increasing the participation, such as cost effectiveness, treatment times and risk of committing new crimes.