The ENGAGE Study
Research type
Research Study
Full title
‘The ENGAGE Study’: A co-produced interview study of forensic mental health patients’ engagement in care using a procedural justice theoretical framework
IRAS ID
316527
Contact name
Jack Tomlin
Contact email
Sponsor organisation
University of Greenwich
Duration of Study in the UK
1 years, 11 months, 31 days
Research summary
Inpatient and community forensic mental health services provide care for people with mental health needs who have offended or are at high risk of harm to themselves or others. However forensic patients experience many restrictions that patients in general psychiatric care do not.
One area where this is apparent is patient engagement in decision making. Many important decisions are made on behalf of forensic patients, for example: to go into involuntary care, to change hospitals, whether they can see their children, or which activities they can participate in.
This co-produced, qualitative interview project will help to develop an understanding about the factors that help or hinder patients’ involvement in decision-making through a procedural justice lens.
Procedural justice theory proposes that where people feel procedures used to arrive at a decision were fair, evidence based, neutral, and gave them a voice, they are more likely to collaborate with authorities.
Our overarching research question is: In what ways can a procedural justice approach help us to understand and improve forensic mental health patients' engagement in care?
We will use a qualitative methodology to conduct semi-structured interviews with 20 forensic patients and 20 members of staff in two London NHS Trusts. Interview data will be analysed using Constant Comparative Analysis. The project will be co-produced by people with lived experience. It will last 24 months.
A Lived Experience Engagement Team will be involved in conducting the project and two co-investigators have lived experience of forensic care. This engagement is co-ordinated with the South London and Maudsley NHS Foundation Trust Involvement Register.
This study will identify concrete actions and outputs that staff working across forensic services can deploy to involve patients in a supportive, safe, respectful, and empowering way, and to generate further our conceptual and theoretical understanding of procedural justice.
LAY SUMMARY OF STUDY RESULTS:
This study explored how patients in forensic mental health services — secure hospitals for people with both mental health needs and criminal justice involvement — can be more fairly and meaningfully involved in decisions about their care. Involvement in care, also known as shared decision-making, means that staff and patients work together to agree on treatment plans and recovery goals. Research suggests that when patients are involved in decisions, they are more satisfied with their care, more engaged in treatment, and have better recovery outcomes. However, little is known about how to achieve this in secure settings, where autonomy is often limited and treatment can be compulsory.Our research used procedural justice theory, which suggests that people are more likely to accept and engage with decisions when they feel they have been treated fairly, listened to, and respected. We carried out in-depth interviews with 15 patients and 14 staff members across two medium-secure hospitals in London. The study was co-produced with a team of people with lived experience of forensic mental health care, who helped design, conduct, and interpret the research.
From these interviews, we developed the PARTNER framework, which identifies seven principles of procedurally fair involvement: Professionalism, Advocacy, Representative fairness, Transparent information, Neutrality, Empathy, and Recognition of voice. When staff acted in ways consistent with these principles, patients said they felt “treated like a human being,” leading to feelings of dignity, hope, and engagement in treatment.
The findings suggest that fairness in everyday interactions — listening, explaining decisions, showing empathy, and acknowledging patient perspectives — can humanise care and strengthen relationships between patients and staff. The study provides practical recommendations for implementing the PARTNER principles across forensic services to support safer, more respectful, and recovery-focused care.
REC name
London - South East Research Ethics Committee
REC reference
23/LO/0923
Date of REC Opinion
4 Jan 2024
REC opinion
Further Information Favourable Opinion