A narrative of recovery in forensic hospitals

Aim

Concerns about the applicability of recovery orientation to forensic care have surfaced due to the traditionally restrictive practices associated with forensic institutions. We interviewed 19 experts-by-experience and 18 professionals working with them across five Finnish forensic hospitals and one out-patient clinic to describe how they define recovery in forensic.

Methods

We utilized semi-structured, one-on-one interviews and then analyzed the collected data using structural narrative analysis. Our points of interest were the plots of the recovery stories and the ways in which various factors affected recovery. We also investigated whether staff and experts-by-experience had different perceptions of recovery in forensic psychiatry, and whether recovery-oriented practices were present in these accounts.

Results

A wider mutual narrative with a chronological plot was identified, and recovery-oriented practices and goals were found with a special emphasis on offending. Insight into mental illness, motivation for self-care, trust in therapeutic relationships, and gaining possibilities to proceed in care were found to promote recovery, whereas insufficient understanding of the illness, a closed environment, lack of trust, and substance abuse hindered the recovery process. Both the professionals and experts felt that the most prominent goal of recovery is integration into society.

Conclusions and implications for practice

The views of the interviewed experts-by-experience and professionals regarding recovery were rather univocal. Forensic psychiatric services in Finland were found to demonstrate recovery-oriented features, which can be promoted further by involving experts-by-experience in different assignments. The results also highlight that the families of patients should become more active partners in care.

Impact and implications statement

Recovery in forensic psychiatric hospitals can be perceived as a process towards a new role in society. To reach this goal the forensic patients need support from staff, peers, and family. We found numerous factors which enable and hinder the recovery process, and which should be considered during forensic care.