Experiences of forensic mental health patients and professionals with shared violence risk assessment and management: A scoping review of qualitative studies

Abstract

Person-centered care and shared decision-making between inpatients and professionals have become guiding principles for mental health care, yet their integration in forensic services remains limited by security-driven and legal considerations. In this context, emerging models of shared risk assessment and risk management could transform forensic patients' experience of, engagement in, and satisfaction with care. However, little evidence informs how shared approaches can improve these experiences of care and be successfully implemented in the forensic context.

A scoping review was conducted to understand the experiences of forensic patients and professionals in implementing shared approaches for violence risk assessment and management. MEDLINE, Embase, CINAHL, PsycINFO and ProQuest were searched for qualitative studies, restricting to inpatient adult settings and interventions targeting hetero-aggression or violence. Raters screened records, appraised quality, and charted findings for narrative synthesis and meta-aggregation.

From 1325 non-duplicate records screened, four articles were selected featuring three multicomponent approaches and one risk assessment tool. Both patients and professionals reported benefits, such as improved therapeutic relationships and patient self-understanding. Participants outlined interpersonal-, intervention-, and organizational-level barriers for patients to effectively influence decision-making. Practice and research implications are discussed, including training needs, how to address and leverage disagreements, and developing organizational change strategies to support shared approaches.