Service users' expereinces of coercion and autonomy in inpatient mental health services

In forensic mental health services, the subject of autonomy is multi-faceted. Many service users in these settings have low motivation, therefore coercive practice may be used to aid recovery and prevent lengthy admissions. Restrictions can also be placed on service user autonomy to protect the welfare of the wider community. However, there is limited research regarding service users’ experiences of autonomy in forensic settings.

This study employed an Interpretative Phenomenological Analysis to explore eleven service users’ subjective experiences of autonomy whilst detained on low secure forensic mental health wards.

Seven superordinate themes emerged; initial expectations of the ward, relationships with staff, perceived lack of autonomy, perceived sense of autonomy, compliance, motivators and changes over time. The findings suggest service users have varied experiences of perceived autonomy which can be influenced by their relationships with staff and perceptions of being provided with choice.

In clinical practice, it could be helpful to consider how service user choice could be increased, such as providing options and ensuring service users feel listened to. It is particularly important to increase opportunities for autonomy as service users near discharge, to enable them to become more independent and break dependency on services.