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Improving Patient Participation at The Forensic Hospital

Justice Health and Forensic Mental Health Network
Project Added:
1 December 2015
Last updated:
3 December 2015

Improving Patient Participation at The Forensic Hospital


The Forensic Hospital implemented collaborative care planning, developed a patient participation framework and recruited a consumer consultant to engage consumers and advocate for their needs.

View a poster of this project from the Centre for Healthcare Redesign graduation, December 2015.

Don't restrict my ability poster


To improve systems that support consumer engagement and peer support at The Forensic Hospital.


  • Improves therapeutic outcomes by fostering a sense of hope and agency.
  • Enhances consumer engagement and participation.
  • Allows services to be more accessible and responsive to consumers’ needs.
  • Improves quality of care.
  • Increases staff satisfaction.
  • Enhances service delivery.

Project Status 

Key dates

  • Project start:  February 2015


Implementation - The initiative is ready for implementation or is currently being implemented, piloted or tested.


The Forensic Hospital is a high security facility for people who have committed a crime and are found not guilty by reason of mental illness.

Despite numerous drivers, patient participation strategies have not been fully realised in The Forensic Hospital. The forensic setting carries additional pressures around safety, restriction and risk, which often seems at odds with open collaboration and genuine participation.

Developing safe and effective processes for engagement and participation are more challenging in an environment where consumers are involuntarily detained and treated for significant periods of time in a system that is inherently authoritative and restrictive. 

The Forensic Hospital completed a hospital-wide MH CoPES survey in 2013. While 91% of patients thought their involvement in decision-making was important, 34% of patients said they were never or rarely involved in decision-making about their treatment. One patient said "I’ve never seen my treatment plan … I’ve been here three years."

Experience trackers, surveys, interviews and focus groups were undertaken with staff and consumers, which identified the following challenges:

  • staff and patients wanted a strong consumer perspective to inform strategic decision-making
  • it was unclear to staff what participation could look like in a high secure setting
  • staff and consumers were concerned about the level of collaboration in current care plan practices, as the current tools (TPRIM) are not easily shared, which limits involvement
  • it was difficult for the project team to decide whether the focus was managing risk or recovery
  • staff had concerns about how to engage people that did not want to be there
  • the necessity for safety and security can lead to a culture of control, which had the potential to lead to a risk-averse culture, defensive practice, paternalism and over-control.

It was clear that new solutions were required, to meaningfully engage consumers and ensure they had greater input into decisions about their care and treatment.


  • An implementation committee was formed and meets regularly to support and sustain progress. It comprises the executive director, service director, director and deputy director of Nursing, contracts manager, allied health manager, corporate operations manager, performance improvement manager, redesign innovation leader and project team.
  • A consumer consultant position commenced in December 2015, to represent the interests of consumers and advocate for their needs.
  • A patient participation framework will be developed by June 2016, which will set out a vision for staff and defined the parameters of participation, to support safe and progressive practices.
  • Collaborative care plans will be implemented in The Forensic Hospital by June 2017.

Implementation site

  • The Forensic Hospital, Justice Health & Forensic Mental Health Network 


  • RichmondPRA
  • NSW Public Mental Health Consumer Workers’ Committee


  • Consumers completed the Your Experience of Service (YES) survey in August 2015.
  • The YES survey will be completed again in August 2016, with results compared to baseline measurements.
  • Patient experience trackers, surveys and focus groups will determine how consumers feel about their treatment and care, following implementation of the project.
  • Staff surveys and interviews will determine whether the patient participation framework supports the role of staff and addresses their concerns about risk and recovery.

Project Team

  • Glen Charlesworth, Senior Occupational Therapist
  • Natalia Yee, Clinical Psychologist
  • Brad Roser, Clinical Nurse Consultant


Glen Charlesworth
Senior Occupational Therapist
Justice Health & Forensic Mental Health Network
Phone: 02 9700 3110

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