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What do the experts by experience tell us about ‘what works’ in high secure forensic inpatient hospital services?

James Tapp, Fiona Warren, Chris Fife-Schaw, Derek Perkins & Estelle Moore

Journal of Forensic Psychiatry & Psychology

Volume 24, Issue 2, 2013, Pages: 160-178



The evidence base for 'what works' for patients detained in high secure hospitals has predominantly been established from a clinical perspective, with the voices of those at the centre of care, the expert by experience, absent. Neglecting this voice renders an important source of information for evidence-based practice inaccessible to outcome evaluators. Twelve high secure patients considered 'ready' to be discharged were interviewed to explore what in their view had helped or hindered their progress to this stage. Thematic analysis steps were applied to interviews and eight themes were generated that represented valued elements of high security: temporary suspension of responsibility, collaboration in care, learning from others, supportive alliances, specific interventions (medical and psychotherapeutic), a safe environment and opportunities for work. Narratives demonstrated the complementary and unique contribution of the patient experience in informing 'what works', and are discussed alongside existing theories relevant to promoting clinical change and risk reduction.



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