Division of Psychology, School of Applied Sciences, London South Bank University, London, UK.
The Open University Business School, Milton Keynes, UK.
Soc Sci Med. 2019 Jan;220:273-282. doi: 10.1016/j.socscimed.2018.11.012. Epub 2018 Nov 10.
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.
中度安保法医精神病学单位是精神卫生服务中更广泛的“庇护后”环境中的独特环境。逗留时间要长得多，实施以康复为重点的护理系统要困难得多，而且缺乏合适的“降级”服务。本研究旨在通过检查社会互动和代理等关键特征，探讨法医精神病学环境如何有助于塑造康复。在这里，我们报告了参与定性视觉研究的患者的发现。这项分析是更大规模的关于工作人员和患者对安全医院空间体验的研究的一部分。在本文中，分析重点是使用社会心理学家 Kurt Lewin 提出的“拓扑学”和“生活空间”概念，探讨康复的两个关键要素——代理和关系，首先，我们探讨了患者在机构空间内相对自由移动的程度，同时又缺乏关系空间。其次，我们探讨了患者在医院的当前生活与过去或即将到来的未来的连接或断开方式如何扩展或压缩生活空间。最后，我们讨论了这些发现对安全法医环境中以个性化和扩展生活空间为重点的康复模式的影响。
