ABSTRACT

Forensic psychiatric inpatients are frequently exposed to aggression from fellow patients during their treatment, but research on how this impacts patients’ well-being and treatment progress is lacking. In this study, we interviewed nine patients on their experiences of victimization during mandatory psychiatric treatment. The interviews were analyzed using a Grounded Theory approach combined with elements from Consensual Qualitative Research and Interpretative Phenomenological Analysis. Three main themes emerged from the data, namely situational descriptives, intrapersonal and interpersonal consequences. Patients were not only exposed to both physical violence and verbal aggression by other patients, but also to a more ubiquitous flow of micro-aggressive comments. Options to escape these situations were limited. This means that victimization processes, which for most patients started much earlier in life, continue during forensic psychiatric treatment. Intrapersonal consequences include fear, hypervigilance, reactive aggression, flashbacks and avoidance and withdrawal. Interpersonal consequences include increased power differences between patients and adverse treatment consequences, such as difficulties with self-esteem. Victimization processes are not always timely noticed in an environment that focuses on risks and treatment of delinquent behavior. A higher level of trauma sensitivity in forensic mental health care is thus required. Recommendations for the implementation of trauma informed care are provided.

摘要

法医精神病住院患者在治疗过程中经常受到其他患者的攻击，但缺乏关于这如何影响患者健康和治疗进展的研究。在这项研究中，我们采访了 9 名患者，了解他们在强制精神病治疗期间的受害经历。访谈采用扎根理论方法结合共识定性研究和解释性现象学分析的元素进行分析。数据中出现了三个主要主题，即情境描述、个人内部和人际后果。患者不仅受到其他患者的身体暴力和言语攻击，而且还受到更普遍的微攻击性评论的影响。逃避这些情况的选择是有限的。这意味着大多数患者在生命早期就开始的受害过程在法医精神病治疗期间继续存在。个人内部后果包括恐惧、过度警觉、反应性攻击、闪回以及回避和退缩。人际后果包括患者之间权力差异的增加和不良治疗后果，例如自尊困难。在专注于风险和犯罪行为治疗的环境中，受害过程并不总是及时发现。因此，法医精神卫生保健需要更高水平的创伤敏感性。提供了实施创伤知情护理的建议。过度警觉、反应性攻击、闪回以及回避和退缩。人际后果包括患者之间权力差异的增加和不良治疗后果，例如自尊困难。在专注于风险和犯罪行为治疗的环境中，受害过程并不总是及时发现。因此，法医精神卫生保健需要更高水平的创伤敏感性。提供了实施创伤知情护理的建议。过度警觉、反应性攻击、闪回以及回避和退缩。人际后果包括患者之间权力差异的增加和不良治疗后果，例如自尊困难。在专注于风险和犯罪行为治疗的环境中，受害过程并不总是及时发现。因此，法医精神卫生保健需要更高水平的创伤敏感性。提供了实施创伤知情护理的建议。在专注于风险和犯罪行为治疗的环境中，受害过程并不总是及时发现。因此，法医精神卫生保健需要更高水平的创伤敏感性。提供了实施创伤知情护理的建议。在专注于风险和犯罪行为治疗的环境中，受害过程并不总是及时发现。因此，法医精神卫生保健需要更高水平的创伤敏感性。提供了实施创伤知情护理的建议。