The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision

Jack Tomlin; Birgit Völlm; Vivek Furtado; Vincent Egan; Peter Bartlett

doi:10.3389/fpsyt.2019.00805

The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision

Front Psychiatry. 2019 Nov 15:10:805. doi: 10.3389/fpsyt.2019.00805. eCollection 2019.

Authors

Jack Tomlin¹, Birgit Völlm¹, Vivek Furtado², Vincent Egan³, Peter Bartlett⁴

Affiliations

¹ Department of Forensic Psychiatry, University of Rostock, Rostock, Germany.
² Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
³ Centre for Family and Forensic Psychology, University of Nottingham, Nottingham, United Kingdom.
⁴ School of Law and Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.

Abstract

Introduction: Forensic psychiatric care is often practiced in closed institutions. These highly regulated, secure, and prescriptive environments arguably reduce patient autonomy, self-expression, and personhood. Taken together these settings are restrictive as patients' active participation in clinical, organizational, community, and personal life-worlds are curtailed. The consequences of patients' experiences of restrictiveness have not been explored empirically. This study aimed to develop a psychometrically-valid measure of experiences of restrictiveness. This paper presents the development, validation, and revision of the Forensic Restrictiveness Questionnaire (FRQ). Methods: In total, 235 patients recruited from low, medium, and high secure hospitals across England completed the FRQ. The dimensionality of the 56-item FRQ was tested using Principle Axis Factor Analysis and parallel analysis. Internal consistency was explored with Cronbach's α. Ward climate (EssenCES) and quality of life (FQL-SV) questionnaires were completed by participants as indicators of convergent validity. Exploratory Factor Analysis (EFA) and Cronbach's α guided the removal of items that did not scale adequately. Results: The analysis indicated good psychometric properties. EFA revealed a unidimensional structure, suggesting a single latent factor. Convergent validity was confirmed as the FRQ was significantly negatively correlated with quality of life (Spearman's ρ = -0.72) and ward climate (Spearman's ρ = -0.61). Internal consistency was strong (α = 0.93). Forty-one items were removed from the pilot FRQ. The data indicate that a final 15-item FRQ is a valid and internally reliable measure. Conclusion: The FRQ offers a novel and helpful method for clinicians and researchers to measure and explore forensic patients' experiences of restrictiveness within secure hospitals.

Keywords: FRQ; autonomy; forensic; forensic restrictiveness questionnaire; mental health; psychometric; restrictive.