The State of Person-Centred Care in Forensic Mental Health Services: Findings from a Nationwide Staff Survey

In the world of healthcare, a powerful idea has taken root: the best care treats a person not as a collection of symptoms or a diagnosis, but as a unique individual with their own history, values, and goals. This approach, known as person-centred care, asks doctors and nurses to listen deeply, share decision-making, and respect the patient's autonomy. It is a standard that most modern hospitals strive to reach. However, there is one place where this ideal seems almost impossible to achieve: forensic mental health. These are secure psychiatric hospitals where patients are treated under legal orders, often because they have committed crimes while suffering from severe mental illness. Here, the primary goals are not just healing, but also public safety, risk management, and security. The walls are high, the routines are rigid, and the freedom of the people inside is strictly limited. It is easy to assume that in such a restrictive environment, the warm, collaborative spirit of person-centred care would be crushed by the need for control.

A team of researchers in Sweden set out to test this assumption. They wanted to know if the staff working in these secure facilities actually felt they were providing care that respected the patients as people. They surveyed 718 staff members across 13 different forensic psychiatric hospitals in the country. These staff members included nurses, assistants, and specialists who work daily with patients in high-security wards. The researchers used a simple questionnaire that asked staff to rate how much they agreed with statements about their work, such as whether they had time to talk with patients, if the environment felt like a home, and if they could adjust their daily routines to fit a patient's needs. They also asked about the conditions of the workplace, specifically whether the staff felt safe, if they trusted the security measures, and if they could speak openly with patients without fear of violence or negative consequences.

The results were surprising. Despite the heavy security and the legal constraints of their work, the staff reported a high level of person-centred care. On a scale where the highest possible score represented a perfect environment for this type of care, the average score was well above the midpoint, landing in the upper range of what is typically seen in other types of healthcare. This suggests that the restrictive nature of forensic hospitals does not automatically prevent staff from seeing and treating patients as individuals. The staff felt that the most important part of their job—building a relationship and understanding the person behind the patient—was happening. They felt they were listening, discussing care plans, and involving patients in their daily activities.

However, the study also revealed where the system struggles. While the staff felt strong in their relationships with patients, they felt less supported by the organization itself. The lowest scores came from questions about the physical environment and the flexibility of their work. Staff noted that patients often could not access outdoor spaces whenever they wanted, that work routines were too rigid to change based on a patient's mood or preference, and that the pressure to finish tasks often got in the way of creating a homelike atmosphere. In short, the staff wanted to be flexible and kind, but the building and the rules often made that difficult. The researchers found that the biggest barrier was not a lack of desire to care, but a lack of time and staffing. When staff felt rushed or understaffed, their ability to provide that extra layer of personal attention dropped.

The study also uncovered a crucial link between safety and care. The staff who felt the most secure in their workplace, who were satisfied with the hospital's security measures, and who felt they could talk openly with patients without fear of violence were the same people who rated their care as the most person-centred. It appears that for a nurse or assistant to truly connect with a patient, they first need to feel safe themselves. If the environment is chaotic or if there is a constant fear of aggression, the staff cannot relax enough to build the trust required for person-centred care. The data showed that when the communication climate was open and the security felt adequate, the quality of care improved. This suggests that safety is not the opposite of care; rather, it is the foundation that allows care to happen.

One might expect that older staff, or those with more education, would feel differently about their work, or that staff in the most secure hospitals would feel more restricted than those in less secure ones. The study found no such differences. The experience was remarkably consistent across the board. Whether a worker had been on the job for three years or thirty, or whether they worked in a large regional hospital or a smaller local one, their perception of the care they provided was the same. This consistency points to a shared reality: the challenges and the successes of person-centred care in these hospitals are shaped more by the overall system and the environment than by individual personality traits.

The researchers concluded that person-centred care is not only possible in forensic mental health, but it is already happening to a significant degree. The staff are managing to keep the human connection alive even within a system designed for control. However, to make this care even better, the focus must shift from trying to change individual staff members to fixing the structural problems. The study suggests that if hospitals can improve staffing levels, create more flexible routines, and ensure that the physical environment supports rather than hinders interaction, the quality of care will rise. The findings indicate that the methods used to improve care in general hospitals can work here too, provided they are adapted to fit the unique safety needs of forensic settings. The staff are ready; the system just needs to catch up.