Patient-oriented research frameworks in forensic mental health settings require specific resources and ongoing consent practicesNew Framework Improves Research for Patients in Mental Health Settings

This paper reports findings from a rapid literature review that informed new guidelines for conducting patient-oriented research in forensic mental health settings. The project adopted an integrated knowledge translation approach at a mental health hospital in Ontario, Canada, engaging a project team that included current forensic patients, hospital staff, and members of an international community of practice. Sources were identified through nine academic databases and targeted grey literature searches, screened independently by two reviewers and extracted using a structured template guided by an a priori framework developed with patients and staff at a knowledge exchange event. Findings were iteratively refined through a patient advisory group, an implementation study, ethnographic observations, and related integrated knowledge translation activities conducted alongside the review. Together, 31 academic and grey literature sources informed a framework organized around five core dimensions: 1) Resourcing, orientation, and training; 2) Confidentiality, consent, and compensation; 3) Relationships, shared understanding, and support; 4) Levels of engagement; and 5) Evaluation and sustainability. Guided by cross-cutting principles common among participatory mental health research, such as dignity, trust, respect, and a commitment to redressing power and attending to forms of epistemic injustice, the guidelines respond to distinctive constraints of forensic environments while highlighting opportunities to promote authentic co-production and sustain patient involvement in research. Recommendations include dedicated resources and capacity-building for patients; relational, ongoing consent practices co-developed with patients; flexible patient researcher roles with fair, paid compensation; and sustained institutional support for participatory practices. We call on forensic hospitals and secure settings to adapt and evaluate these guidelines and to invest in expanding patient leadership to advance the field.