Forensic psychiatry and mental health in Australia: an overview

Conducting mixed methods research with women in a forensic mental health setting: A reflexive account from a nurse as researcher

AIMS

To describe a reflexive account of a mental health nurse as researcher undertaking a mixed methods study as part of a doctoral degree, with women in a secure forensic hospital.

DESIGN

A discursive paper that draws upon the primary author's experience of dual roles as a mental health nurse and a novice researcher, and relevant literature pertaining to positionality and reflexivity in the context of conducting mixed methods research.

METHODS

A mixed methods study was conducted within a secure forensic hospital in Australia, to identify factors associated with the frequency and duration of seclusion for women and, to explore their experiences of seclusion. Notes and a reflective diary were used to demonstrate the reflexive approach and strategies used throughout the study design and data collection stages of the research.

RESULTS

Women in the secure forensic hospital setting often have complex histories and experiences and are considered a vulnerable group, which can add additional challenges when undertaking research with this population. As a doctoral student with clinical experience in mental health undertaking research in the forensic hospital setting with women, positionality and the connection with reflexivity requires exploration to understand self and the influence on research. This understanding along with identified strategies to enhance reflexivity, supports the management of the dual nurse as researcher roles to enhance all stages of the research process.

CONCLUSION

Doctoral nursing candidates undertaking clinical research in their area of clinical practice and at the location of previous employment, may experience challenges in relation to identity and the dichotomy of roles. Further challenges can be posed when research involves complex populations and/or controversial practices. Support to balance role conflict and maintain reflexivity is critical to understanding the role of self in research and to enhance credibility.

IMPLICATIONS FOR THE PROFESSION AND/OR CLINICAL PRACTICE

Women are a complex, yet minority population in forensic mental health settings, however the numbers of women being admitted to services is increasing. Future research may consider the use of the strategies explored here to enhance the reflexive process, and support future researchers in this field to conduct research that aims to support an often-misheard population to better support health outcomes.

PATIENT OR PUBLIC INVOLVEMENT

There was no patient or public contribution to this paper, however the study in which this paper is based on, is grounded in the experience of patients (women).

Eliciting an offence narrative: what types of questions do forensic mental health practitioners ask?

Maximising the accuracy and detail of information elicited through a clinical-forensic interview may increase the reliability and validity of an individual's assessment. Despite this, there is little empirical research on what questions forensic mental health practitioners employ, and whether these correspond with empirically established interviewing strategies. In this study, 22 forensic mental health practitioners participated in a mock interview of a young person referred for a sexual risk assessment. The results highlighted that participants asked very few 'open' questions, over-relied on 'specific' questions and an average of 13% of questions were leading. Finally, practitioners predominantly used 'yes/no' questions when exploring the young person's thoughts, feelings, and physiological responses. Overall, the study demonstrated that empirically supported interviewing techniques were not commonly employed and highlighted the need for further professional development and training around clinical forensic interviewing strategies that best elicit the information needed to inform risk assessment.