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Court hearings concerning the continuation of forensic psychiatric care in Sweden - Experiences, perceptions and reactions within patients and caregivers

Within the Swedish legal system, an individual can be sentenced to forensic mental care as penalty for a committed crime, given that the offender is deemed to be suffering from a severe mental illness that is causally linked to the crime. The continuation of forensic mental care is tried in administrative court hearings every six months. When the patient objects to the recommendations of the chief psychiatrist at the treatment facility, these proceedings will be adversarial in nature, with little chance of the patient’s wishes being heeded.

At present we lack knowledge of how these proceedings are understood and experienced by patients and psychiatrists or how parties in these proceedings view and understand certain aspects of the proceedings, such as the expertise of involved parties and how competing ethical values are handled. We also lack knowledge of how these proceedings affect the patients’ rehabilitation. Anecdotal evidence suggest that these regular court hearings are a source of stress and feelings of powerlessness, factors that have been associated with exacerbated psychiatric symptoms such as depression and psychosis. Preliminary data also suggest that these hearings may affect the treatment alliance between patient and their treating psychiatrist. This is a factor that has been linked to the efficacy of psychiatric rehabilitation.

The proposed project includes two prospective, quantitative studies to investigate the effects of these proceedings on patient’s symptoms, levels of stress and feelings of inferiority, entrapment and defeat as well as the effects on the working alliance between patient and psychiatrist. Data collection for these two studies will be joint, with an estimated 200 patients and their treating psychiatrists completing well established rating scales for both studies at the same time points. These time points will be set three months apart, adjacent to the court hearing and in between two hearings. Data collection will continue for eighteen months for each participant, totaling approximately two years of data collection. A third, interview based study is also planned. A group of 20 patients and 5 psychiatrist will be interviewed in depth about their experiences and understandings of the legal proceedings and their purposes. They will also be interviewed briefly at three times, adjacent to the court hearings, over eighteen months. These brief interviews will focus on experiences of the latest court hearing, any deviations from previous experiences and how these deviations affected the participant’s perception of the procedures.

The proposed project entails both qualitative and quantitative methods in a mixed methods design, a design that has become increasingly common. These methods stem from different research traditions with different premises regarding, for instance, epistemology and the fundamental ambition of science. It is unclear to what extent these premises can be maintained in joining the methods. The proposed project includes an analysis of the research methodology entailed, focusing on the epistemological foundations and basic scientific ambitions of each methodology and whether these aspects can be combined or fused in a project of this nature. Hence, the project is interdisciplinary, drawing from the fields of psychiatry as well as theory of science and philosophy of science.

Principal Investigator: Sven Pedersen

Contact Information

Sven Perdersen

Contact Information

Sven Perdersen


Page Manager: Stefan Axelsson|Last update: 5/19/2016

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