A research first for patient engagement

The Challenge: Do forensic psychiatric patients benefit from patient-centred care?

Patients in forensic psychiatric hospitals are different than others who suffer from mental illness: they have committed a crime for which they have been found not criminally responsible on account of their mental disorder. Nevertheless, they suffer from mental illness that needs treatment. And research has convincingly found that involving patients in their own care is important for achieving high-quality and effective mental health services. Still, the question remains: Can the principles and practices of patient-centred care be achieved in a forensic hospital environment?

The Improvement Project: Three patient-led teams

The BC Forensic Psychiatric Hospital (FPH), supported by the Canadian Foundation for Healthcare Improvement sought to improve the quality of care through patient engagement. Led by Dr. Johann Brink, the project established three teams of patients: the Patients Empowered and Engaged as Researchers (P.E.E.R.) program, a patientled research team to design and implement a research project examining perceptions of treatment planning among patients and staff at the FPH; the Peer Support Program, to deliver group-based and individual support for patients; and the Patient Advisory Committee, to ensure that the perspectives and opinions of patients would become integral for decision-making and service provision within the hospital. Team members kept journals about their involvement, where they could express their excitement, their apprehension and their satisfaction.

The Result: Significant progress in planning and delivering treatment

Throughout the project, the P.E.E.R. team invited patients to express their thoughts about who should be included on treatment teams, how team meetings should be conducted and the importance of patient involvement in the development of treatment plans. Since March 2011, P.E.E.R has identified research priorities and methodologies. It began to collect data in October 2011 to learn how treatment planning is perceived and experienced by patients and staff in a forensic psychiatric hospital. The Peer Support Program has delivered groupbased support to 35 patients and one-on-one support to 60 patients. These teams, as well as the Patient Advisory Committee, continue to evolve as challenges are encountered and as other patient and organizational needs are identified.

One patient participant said: “I was fairly nervous when we first started doing practice interviews—I didn’t think I would be any good at it. In fact, I received plenty of good feedback, which gave me more confidence the next time I had to interview.”

The Impact: Shifting organizational culture to better align provision of care with a patient-centered approach

The project, which is ongoing, has successfully engaged patients in the very research that helps demonstrate that patient engagement is possible in a forensic psychiatric hospital. In what team leaders call “the most democratic process you will ever see for choosing a research project,” team members selected the topic through three rounds of voting on what were originally 38 potential research topics. The project is noteworthy for more than its topic selection process; it also marked the first time patients had attended and presented at clinical staff meetings, the first time patients had conducted research interviews and the first time forensic psychiatric patients had attended and presented at the annual Pacific Forensic Psychiatry Conference.

Johann Brink image

Johann Brink
Clinical Professor, Psychiatry, UBC
Mental Health and Addictions Research Network
VP, Medical Affairs and Research at BC Mental Health
Vancouver, BC