Abstract
Recovery orientation (RO) is a modality of supporting patients to improve self-determination, leading a meaningful life and well-being in general. This approach is widely studied in general psychiatry, but evidence is lacking for forensic inpatient settings in Switzerland. While secure forensic clinics tend to be regarded as total institutions, which are an anathema to RO, a project to implement RO interventions in this setting was financed by the Swiss Federal Office of Justice. This explorative study investigates baseline expectations and views of patients in forensic wards in German-speaking Switzerland in the context of a recovery-oriented intervention. As such wards are non-existent in Latin-speaking Switzerland, the investigation could only be carried out in this language region. Six focus groups with 37 forensic inpatients were conducted. Thematic analysis revealed two major and several subthemes. The major theme “heteronomy” includes the subthemes “stigmatization and shame,” “coercion,” “lack of support,” “mistrust,” “waiting,” and “structural impediments.” The subthemes “learning to live with the disorder and working on oneself,” “participation,” “connectedness,” “confidence,” and “joie de vivre” belong to the major theme “regaining self-determination.” In this way, results of prior research are extended to forensic peculiarities. Furthermore, the personal views of patients are discussed in detail regarding their possible influence on therapeutic outcomes and personal recovery. These findings should be of help to therapeutic staff in the respective setting to be better informed about, and to counter the effects of, heteronomy and long-term hospitalization. Important in this regard is the concept of procedural justice and the subjective client's perception thereof.
Highlights
Putting a focus on personal recovery is well established [1] in international psychiatric care systems
This paper reports the results of the analyses of six forensic inpatient focus groups, which have been held between February and June 2020 in two corresponding University hospitals for forensic psychiatry in German-speaking Switzerland
The thematic analysis revealed a bipolar structure, whereas its two poles were defined by the vertical global themes “Heteronomy” and “Regaining selfdetermination.”
Summary
Putting a focus on personal recovery is well established [1] in international psychiatric care systems. Drennan and Wooldridge [8] developed a briefing about making recovery a reality in forensic settings and identified five key areas, which could be of help in developing a recovery friendly climate These key areas are supporting recovery along the care pathway, the quality of relationships, risk and safety, opportunities for building a “life beyond illness”—meaningful occupation, and peer support. Their comments on the key areas reflect the important factors mentioned above and show ways of putting them into practice
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