Tug of war: service users’ experience of care and treatment planning in a forensic mental health service using Foucauldian discourse analysis

Purpose With the recent drive for services providing care for people with offending backgrounds to adopt a more psychologically informed approach, it is integral to understand how receiving care and treatment is talked about. People’s care when detained within a Welsh Forensic Mental Health Service (FMHS) is restricted by the Mental Health Act (MHA, 1983) and managed with a care and treatment plan approach under the Mental Health Measure (NHS Wales, 2010). This study aims to explore people’s experiences of receiving care within an FMHS. Design/methodology/approach Foucauldian discourse analysis (FDA) was used to analyse interview transcripts from seven people who were receiving care within an FMHS. The interviews explored discourses of receiving care within an FMHS. Particular attention was paid to the Foucauldian concepts of knowledge, power, objectification, subjectification and surveillance. Findings Three main discourses and two alternative discourses emerged. Participants perceived the power to be held within FMHS and spoke of being in a constant battle of trying to hold onto power within a system that holds power. Knowledge about the systemic factors that influence the distribution of power was shared and participants reflected on the differences between the “internal” world of FMHS and the “outside” world. Participants’ experiences were shared through a lens of perceived powerlessness. Practical implications Overall, the people receiving care should be acknowledged as experts of their own experience, with their knowledge shared, listened to and respected. Originality/value To the best of the authors’ knowledge, this is believed to be the first paper exploring people’s experiences of care within an FMHS from an FDA perspective.