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Care & custody: E-sport and patient-professional power-relations in forensic psychiatry. A qualitative study

Published online by Cambridge University Press:  13 August 2021

M. Terkildsen*
Affiliation:
Department Of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus N, Denmark Defactum, Central Denmark Region, Aarhus N, Denmark
H. Kennedy
Affiliation:
Department Of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus N, Denmark Department Of Psychiatry, Trinity College- Dublin University, Dublin, Ireland National Forensic Mental Health Service, Central Mental Hospital Dundrum, Dundrum, Ireland Institute Of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
A. Di Lieto
Affiliation:
Department Of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus N, Denmark
B. Jensen
Affiliation:
Department Of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus N, Denmark
L. Uhrskov
Affiliation:
Department Of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus N, Denmark Institute Of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
*
*Corresponding author.

Abstract

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Introduction

Recovery orientated care emphasizes equality in relations. Forensic psychiatric professionals need to engage in care-relationships with patients in ways where power is symmetrically distributed among them. However, professionals also need to focus on security at the ward. This promotes patient-professional power-relations that are asymmetrically skewed towards professionals. New practical ways of balancing between the power-relations defined by a care and custody dichotomy in forensic care need to be developed and studied to guide clinical practice.

Objectives

To study how power-relations are articulated between patient-professional within a social gaming activity (E – sport) in a Danish medium secure forensic psychiatric ward.

Methods

Three months of observational data, collected via anthropological fieldwork Interviews with 3 professionals and 6 patients Data was analyzed using sociologist Pierre Bourdieu’s notions of field, capital and power

Results

The E-sport intervention consists of two fields “in-game” and “over-game” In-game concerns the practice of gaming Over-game concerns the interventions organization Power in each field is driven by specific values and access to certain competencies Power in-game was equally open to patients and professionals leading to symmetric power relations Power over-game was open to professionals only leading to asymmetrical power relations Professionals may allow power distribution to patients during gameplay, while still retaining the overall power over the intervention

Conclusions

It is possible to balance between care-and-custody in forensic psychiatry. This study provides important insights to guide further practice.

Type
Abstract
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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