An exploration of perceived coercion into psychological assessment and treatment within a low secure forensic mental health service

Abstract

Psychologists working within forensic mental health (FMH) services face challenges around supporting clients’ informed consent when engaging in psychological assessment and treatment. Given that there is little research in this area, this qualitative study interviewed ten forensic inpatients from a low secure FMH service, to determine the impact of any perceived coercion to engage with psychologists. Interviews were transcribed and subject to Thematic Analysis. Three over-arching themes emerged from the analysis: ‘Awareness of Coercive Power’, ‘Experiencing and Responding to Coercion’ and ‘Psychological Treatment is Helpful, But…’. Participants perceived coercion to engage with psychologists. Perceived coercion led to psychological distress, wanting to resist, and superficial engagement. Despite this, therapeutic alliance was established with the psychologist but the quality of the therapeutic alliance was compromised. The findings have implications for psychologists working in FMH services. Suggestions for reducing perceived coercion and future directions for research are discussed.

Keywords:

• coercion
• forensic mental health
• informed consent
• power
• psychological assessment
• psychological treatment
• therapeutic alliance

Ethical standards

Declaration of conflicts of interest

Cassandra Simms-Sawyers has declared no conflicts of interest

Helen Miles has declared no conflicts of interest

Joel Harvey has declared no conflicts of interest

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study