title: Supporting recovery by improving patient engagement in a forensic mental health hospital: results from a demonstration project.
abstract: BACKGROUND
  Mental health services are shifting toward approaches that promote patients' choices and acknowledge the value of their lived experiences.
  
  
  OBJECTIVE
  To support patients' recovery and improve their experiences of care in a Canadian forensic mental health hospital, an intervention was launched to increase patient engagement by establishing a peer support program, strengthening a patient advisory committee, and creating a patient-led research team.
  
  
  METHODS
  The effect of the intervention on patient- and system-level outcomes was studied using a naturalistic, prospective, longitudinal approach. Quantitative and qualitative data were gathered from inpatients and service providers twice during the 19-month intervention.
  
  
  RESULTS
  Despite succeeding in supporting patients' participation, the intervention had minimal impacts on internalized stigma, personal recovery, personal empowerment, service engagement, therapeutic milieu, and the recovery orientation of services. Peer support demonstrated positive effects on internalized stigma and personal recovery.
  
  
  CONCLUSIONS
  Strengthening patient engagement contributes toward improving experiences of care in a forensic hospital, but it may have limited effects on outcomes.
authors.affiliation: Simon Fraser University, Burnaby, British Columbia, Canada. dr.jdlivingston@gmail.com
authors.forename: James D
authors.initials: JD
authors.lastname: Livingston
authors.forename: Alicia
authors.initials: A
authors.lastname: Nijdam-Jones
authors.forename: Sara
authors.initials: S
authors.lastname: Lapsley
authors.forename: Colleen
authors.initials: C
authors.lastname: Calderwood
authors.forename: Johann
authors.initials: J
authors.lastname: Brink
mesh_terms: D000328:Adult; D026683:Advisory Committees / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D002170:Canada; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D003299:Cooperative Behavior; D005260:Female; D006778:Hospitals, Psychiatric / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D006801:Humans; D007298:Insanity Defense; D033183:Interdisciplinary Communication; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000451:nursing* / Q000534:rehabilitation*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D010348:Patient Care Team / Q000458:organization & administration; D010349:Patient Compliance / Q000523:psychology*; D010358:Patient Participation / Q000331:legislation & jurisprudence* / Q000523:psychology*; D017060:Patient Satisfaction; D010379:Peer Group; D011209:Power, Psychological; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000451:nursing / Q000534:rehabilitation; D012106:Research / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D012559:Schizophrenia / Q000451:nursing / Q000534:rehabilitation; D012944:Social Support; D019966:Substance-Related Disorders / Q000451:nursing / Q000534:rehabilitation
keywords: forensic mental health; participatory action research; patient engagement; peer support; recovery