Exploring staff experiences of therapeutic relationships and team formulation in inpatient forensic mental health services

Abstract

Forensic Mental Health (FMH) services represent a complex service area with competing political, legal and health care demands. Members of staff working within these services must navigate the competing demands of care and control and have an important influence on how FMH services function and the quality of care that is provided. A systematic search strategy was developed and PsycINFO, Medline, CINAHL, Web of Science, EMBASE and grey literature were searched. A qualitative meta-ethnography of papers from the United Kingdom explored how power, control and risk management influence staff experiences of the therapeutic relationship (TR) in inpatient FMH services. Three third-order themes emerged from this synthesis: 1) Staff team cohesion; 2) Dialectic between care and control; and 3) Structural systems. The findings highlight the dynamic process in which staff hold dual-roles between care and control and the importance of staff team cohesion, safety and containment when fostering TRs. Semi-structured interviews were conducted with 12 staff members from multi-disciplinary teams in an inpatient FMH service in the UK. A thematic analysis was conducted, yielding three themes: 1) Processes and parallel processes; 2) Mechanisms for change; and 3) Barriers to successful intervention. A process model is presented, which highlights six stages involved in team formulation interventions and is discussed in relation to the themes. This model adds to the limited existing literature and provides facilitators with a flexible framework of key factors to consider during team formulation interventions. A critical appraisal summarises the findings of the review and research paper and reviews the process of carrying out research in FMH settings. Ethical issues of indirect working are also discussed.