ABSTRACT

Forensic mental health settings are complex, influenced by legal, clinical and policy paradigms. Patients are generally subject to mandatory detention, psychiatric treatment and supervision. Social reform has resulted in implementation of the recovery paradigm in mental health services, which advocates least-restrictive practice, empowerment, hope and collaborative decision-making. However, there is tension between the recovery paradigm and risk management in forensic mental health settings. Eight forensic residents of a forensic step-down rehabilitation unit (FSDRU) were interviewed about their experiences in and attitudes towards the unit. Thematic analysis identified five main themes: two associated with the treatment context of Mental Health Recovery (Mental Health Management, Relationships) and three associated with the Forensic Setting (Court Influence, Resident Journeys and FSDRU). The FSDRU model was regarded as adaptive, supportive, well-considered and multi-faceted, owing to the FSDRU setting, risk management approach and fostering of positive peer and staff relationships. Resident perspectives indicated that the recovery model had been implemented effectively and was feasible for forensic residents, although many aspects were affected by the judicial system.

摘要

法医精神卫生设置很复杂，受法律，临床和政策范式的影响。患者通常会受到强制拘留，精神病治疗和监督。社会改革导致了精神卫生服务恢复范式的实施，该范式倡导限制性最小的实践，赋权，希望和协作性决策。但是，法医精神健康环境中的恢复范式与风险管理之间存在紧张关系。采访了法医降级康复科（FSDRU）的八名法医居民，他们在该科的经验和态度。主题分析确定了五个主要主题：两个与心理健康恢复的治疗背景有关（心理健康管理，人际关系）以及与司法环境相关的三个要素（法院影响力，居民旅程和FSDRU）。由于FSDRU的设置，风险管理方法以及建立良好的同伴和员工关系，FSDRU模型被认为是适应性，支持性，考虑周全和多方面的。居民的观点表明，尽管许多方面受到司法系统的影响，但恢复模型已得到有效实施，并且对于法医居民而言是可行的。