Forensic psychiatry in times of COVID-19: a qualitative study into the concerns and needs of patients

Purpose The aim of this study is to gain a better understanding of the concerns and needs of forensic psychiatric patients regarding the impact of the COVID-19 crisis on their mental health and treatment. Design/methodology/approach Semi-structured interviews were conducted with nine patients from various wards of the hospital. Using the consensual qualitative research method, these interviews were coded by a team of three researchers. Findings Four domains emerged from the analysis, namely, restrictions, emotional consequences, coping and communication. One of the primary restrictions for patients was not being allowed to have physical contact with the people in their network/visitors. This prompted patients, in some cases, to decline visitors altogether. Emotional consequences of the COVID-19 measurements included anxiety, frustration and passivity. Ambiguity about the rules added to this frustration. Furthermore, a cut in autonomy was felt by patients due to them not being able to do their own grocery shopping. Despite these restrictions that were imposed on patients, the relationship between patients and staff was perceived as good and even improved according to the participants. Practical implications A lack of autonomy emerged as a salient issue related to the restrictions within the hospital. Certain degrees of control may be inevitable, but it is nonetheless important to focus on the effect of control within forensic settings. This could be done by aiming to actively include patients in decisions that affect their living climate. Furthermore, it appeared that the "ballet dancer" approach was used by the staff of the hospital, leaving more room for individualized care. As perceived support is important to increase willingness to accept the treatment being offered, a focus on this approach in times of rapid change such as during a pandemic, would be recommended. Originality/value Because few pandemics have occurred in the past century, little information is available about how a pandemic might affect patients residing in forensic psychiatric hospitals. To the best of the authors' knowledge this is one of the first studies to assess concerns and needs of forensic psychiatric patients regarding the COVID-19 pandemic.