Agents and spectres: Life-space on a medium secure forensic psychiatric unit [2018]


• secure psychiatric care in the UK has failings around patient autonomy and choice.

• Reforms have focused on improving the built environment rather than relationships.

• Patients have more physical space to move but feel there is less psychological space.

• Neglecting the temporal dimension of relationships impairs recovery.

• secure care should be designed around a relational mapping of patients’ experiences.

Medium secure forensic psychiatric units are unique environments within the broader ‘post asylum’ landscape of mental health services. Length of stay is much greater, a recovery-focused care system is much more difficult to implement, and there is a paucity of suitable “step-down” services. The aim of this study was to examine how forensic psychiatric environments contribute to the shaping of recovery, by examining key features such as social interactions and agency. Here, we report on the findings from patients participating in a qualitative-visual study. This analysis forms part of larger study on staff and patient experiences of secure hospital space. In this paper, the analytical focus is directed towards two key elements of recovery – agency and relationality, using the concept of ‘topology’ and ‘life-space’, developed by the social psychologist Kurt Lewin. First, we explore how patients have relative freedom to move within institutional spaces, yet lack relational space. Secondly, we explore how life-space is expanded or compressed by the manner in which the patient’s present life in hospital is connected or disconnected from their past or pending future. Finally, we discuss the implications of these findings for a recovery model within secure forensic settings, focused on personalisation and expanded life-space.

P. Reavey, S. D. Brown, A. Kanyeredzi, L. McGrath, I. Tucker
Social Science & Medicine, Volume 220, January 2019