The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision.

Jack Tomlin,Birgit Völlm,Vivek Furtado,Peter Bartlett,Vincent Egan

doi:10.3389/fpsyt.2019.00805

Abstract

Introduction: Forensic psychiatric care is often practiced in closed institutions. These highly regulated, secure, and prescriptive environments arguably reduce patient autonomy, self-expression, and personhood. Taken together these settings are restrictive as patients’ active participation in clinical, organizational, community, and personal life-worlds are curtailed. The consequences of patients’ experiences of restrictiveness have not been explored empirically. This study aimed to develop a psychometrically-valid measure of experiences of restrictiveness. This paper presents the development, validation, and revision of the Forensic Restrictiveness Questionnaire (FRQ). Methods: In total, 235 patients recruited from low, medium, and high secure hospitals across England completed the FRQ. The dimensionality of the 56-item FRQ was tested using Principle Axis Factor Analysis and parallel analysis. Internal consistency was explored with Cronbach’s α. Ward climate (EssenCES) and quality of life (FQL-SV) questionnaires were completed by participants as indicators of convergent validity. Exploratory Factor Analysis (EFA) and Cronbach’s α guided the removal of items that did not scale adequately. Results: The analysis indicated good psychometric properties. EFA revealed a unidimensional structure, suggesting a single latent factor. Convergent validity was confirmed as the FRQ was significantly negatively correlated with quality of life (Spearman’s ρ = −0.72) and ward climate (Spearman’s ρ = −0.61). Internal consistency was strong (α = 0.93). Forty-one items were removed from the pilot FRQ. The data indicate that a final 15-item FRQ is a valid and internally reliable measure. Conclusion: The FRQ offers a novel and helpful method for clinicians and researchers to measure and explore forensic patients’ experiences of restrictiveness within secure hospitals.

Highlights

Forensic psychiatric care is often practiced in closed institutions
Items on the Forensic Restrictiveness Questionnaire (FRQ) were derived from interviews
Patients described: restrictions on their sense of self given their treatment in forensic hospitals, the limited range and meaningfulness of activities, the prospects of reintegration into the community, the pathologization by staff of patient behaviors, reduced possibilities to exercise choice, and relationships with others inside and outside the hospital as restrictive and restricted [29]

Summary

Introduction

Forensic psychiatric care is often practiced in closed institutions. These highly regulated, secure, and prescriptive environments arguably reduce patient autonomy, self-expression, and personhood. Taken together these settings are restrictive as patients’ active participation in clinical, organizational, community, and personal life-worlds are curtailed. This study aimed to develop a psychometrically-valid measure of experiences of restrictiveness. This paper presents the development, validation, and revision of the Forensic Restrictiveness Questionnaire (FRQ). Secure hospitals aim to provide a safe, therapeutic milieu in light of restrictive risk-averse policies and practices. Efforts to provide mental health care in the least restrictive environment possible are recognized internationally. In the UK, policy and best practice guidelines that reference least restrictive practice are ubiquitous [4,5,6,7,8,9,10,11]

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Conclusion