This is a mixed research methods study based at the forensic mental health unit of Weskoppies Psychiatric Hospital in Pretoria, Gauteng Province, South Africa. The overarching aim of the study was to help add insights that could indirectly inform the wider discourse on sexual offending in society and to the body of knowledge on the prevention of sexual violence – including in forensic mental health. Qualitative and quantitative methods were applied through concurrent and transformative mixed research methods, premised on the philosophical stance of pragmatism. Records of individuals accused of sexual offences were explored and in-depth interviews with individuals accused of sexual offending and / or other types of charges referred for observation in terms of the Criminal Procedure Act, 51, 1977 (CPA 1977) were conducted. Psychiatric and psychosocial features and general perspectives on sexual offending were explored. Data collection was done from the end of 2014 to the end of 2015. In terms of findings, the record-based component of the study revealed that the majority of those referred were mentally capable, were known to the victims and lived in close proximity to them. Boys and girls, elderly women and socially isolated individuals seemed the most vulnerable irrespective of the mental capacity of the accused at the time of an alleged incident. In-depth interviews revealed scepticism, myths and new locally relevant ways of defining sexual violence. Socio-economic determinants of health seemed to render potential perpetrators of sexual offending vulnerable to violence and included adverse childhood events, poverty, unemployment and inequality. Experiences during and after arrest revealed possible human rights violations of alleged offenders by communities and law enforcement systems. Mental illness worsened stigma even in the hands of law enforcement systems. Central phenomena viz. ‘the perceived oppression of men’ and ‘vulnerability’ of potential victims and potential perpetrators emerged. A tentative theory of ‘vulnerability’, as an explanation and an approach to preventing sexual and other forms of violence in society, is proposed for both victims and potential perpetrators. Public health, socio-ecological frameworks of sexual violence prevention and other explanatory and prevention frameworks on sexual offending seem aligned to the study’s findings. Patriarchy, collective violence inherited from South Africa’s past, social cognitive theory on learning, trauma re-enactment, and other factors seem to play a role. In terms of mixed research contributions, a need for robust ways of studying diverse populations such as South Africa is emerging. Further, an initial stance of studying prevention of sexual violence from a victim-centred advocacy lens, has been transformed to yield accused individuals’ advocacy issues as well. Multi-system prevention approaches involving at-risk potential perpetrators, and not just victims, seem to be the next frontier for research and interventions. The study reveals insights that may contribute to the field of violence prevention. / Thesis (PhD)- University of Pretoria, 2018. / Psychiatry / PhD / Unrestricted

The institute of preventive detention is a new protective measure in our penal law. The theme of this thesis is an analysis of the comission and goals of the new protective measure and focusing on a comparation of theoretical and practical function of this protective measure. The folowing chapters provide the characterization of the preventive detention and its legal framework in the Czech republic. The component part of the thesis is also a description of the preventive detention in a legal framework of other state, concretely Slovakia. At the end of the work there are explicated knowledges obtained during the visit of the Institute for preventive detention Brno. In this chapter not only functional equipment is described but also the compositon of the inmates and employees and their most important competencies. Programms, by which are the medical goals fullfiled are described at the end of the thesis.

Thesis (M. Medicine (Psychiatry)) -- University of Limpopo, 2022 / BACKGROUND: The challenge of sexual offence crimes against women and children is notably increasing worldwide with an accompanying impact on the mental and physical well-being of the victims and society, in general. Despite the impact, sexual offenders remain a complex group, not well studied in forensic psychiatry settings globally. Previous studies identify psychosocial factors and mental illness associated with sexual offending. Adequate care, treatment and rehabilitation of sexual offenders are crucial to reduce the impact of sexual offence and re-offending. AIMS: To determine the demographic variations, clinical factors, and observation outcomes in terms of diagnosis, fitness to stand trial, and criminal responsibility among the alleged sexual offenders referred to Thabamoopo Hospital. OBJECTIVES: To determine the prevalence of mental disorders among alleged sexual offenders, to determine the number of offenders fit or unfit to stand trial and who are criminal or not criminally responsible, to determine factors associated with vulnerability to sexual offending behaviour. METHOD: This study is based on a review of clinical records and files and psychiatrists' observation reports of all alleged sexual offenders referred by the courts for forensic psychiatric observation between the period January 2015 to December 2018 at Thabamoopo Hospital. RESULTS: The sample consists of 94 participants, only one female; all were black Africans. The majority were in middle adulthood, unemployed, of a lower level of education and not married. All participants had been charged with rape. A large number of the alleged sexual offenders were diagnosed with mental conditions. The most common diagnoses were Intellectual disability disorders, psychotic disorders and substance-related disorders. More than half of the sample was fit to stand trial and criminally responsible. CONCLUSION: More than half of the participants charged with rape were found fit to stand trial and to be criminally responsible. A significant number were diagnosed with mental illness. The outcomes of being unfit to stand trial and not being criminally responsible were common among mentally ill sexual offenders. The results signify that this group of offenders needs adequate psychiatric care, treatment and rehabilitation in order to reduce sexual offending and re-offending due to the impact of mental illness.

Au Canada et ailleurs dans le monde, le système judiciaire occupe une place de plus en plus importante dans la prise en charge des personnes vivant avec un trouble mental grave. Le rôle du système judiciaire comme levier d'accès aux soins est particulièrement évident dans le cas des personnes déclarées non criminellement responsables pour cause de troubles mentaux (NCR). La vaste majorité des personnes déclarées non criminellement responsables pour cause de troubles mentaux (NCRTM), formant la clientèle principale des services psycho-légaux, était déjà connue des services de santé mentale. Cela questionne la présente capacité du réseau à répondre aux comportements perturbateurs et fait ressortir la possibilité de prévenir le potentiel passage à l’acte et la trajectoire judiciaire subséquence. La présente thèse de doctorat utilise des données administratives provenant des secteurs de la santé, de la justice et de la sécurité publique pour plus de 1 000 personnes qui ont reçu un verdict de non-responsabilité criminelle au Québec. Ces données sont complétées par des entrevues qualitatives avec des parties prenantes. Ensemble, l’analyse de ce corpus de données permettent de mettre en lumière les barrières à l'accès aux soins et les interruptions de services que subissent, dans leur parcours de soins, les personnes atteintes de troubles mentaux sévères et ayant des comportements perçus comme perturbateurs ou dangereux qui les rendent susceptibles d’être judiciarisés. Le premier article décrit les tendances d’utilisation de services de santé et des réclamations de médicaments sur ordonnances dans l’année précédant une infraction qui a entraîné un verdict de NRCTM. Les résultats indiquent que – bien que des résultats antérieurs montrent que plus de 70 % des personnes NCRTM avaient déjà été en contact avec des services pour des raisons de santé mentale – moins de la moitié des personnes déclarées NCRTM avaient bénéficié d’une réelle prise en charge médicale avant l’incident. Les résultats montrent également qu’une personne sur cinq avait commis l’infraction moins d'une semaine après le contact de santé mentale le plus récent. Parmi celles qui avaient au moins une prescription pour un antipsychotique, près de la moitié ne prenaient pas d’antipsychotique au moment de l’infraction. Le deuxième article identifie les facteurs individuels et contextuels facilitants et ceux faisant obstacles à l’accès aux services de santé mentale dans la période avant le délit. Les considérations géographiques jouent un grand rôle dans la possibilité d’accéder et de recevoir les services de santé mentale spécialisés – au-delà des facteurs individuels liés aux besoins. De plus, vivre avec des proches diminue de moitié la probabilité d’aller chercher des services de santé mentale et diminue l’intensité de l’utilisation de services de santé mentale spécialisés, même en tenant compte et ajustant les modèles pour les besoins. Finalement, le troisième article repose sur l’analyse d’entretiens individuels et de groupes d’entretiens focalisés avec 16 personnes ayant de l’expérience vécue (pairs aidants, proches aidants), des praticiens et des administrateurs. Les résultats mettent en évidence comment les expériences passées de stigmatisation, de traumatisme, d'inefficacité et de discrimination au sein d'un système hospitalo-centrique influencent la capacité des utilisateurs de services et des proches aidants à chercher et à s'engager dans les soins. Les mécanismes d'accès existants en période crise, tels que l'intervention policière et les services d'urgence, sont des options inacceptables pour les utilisateurs de services et leurs aidants familiaux et sont donc souvent considérés comme des derniers recours. Par conséquent, les utilisateurs de services entrent dans le système de santé avec des besoins complexes qui sont difficiles à traiter avec les connaissances cliniques actuelles et qui résultent bien souvent en des mesures coercitives plutôt qu’axées sur le rétablissement. Les résultats peuvent être interprétés à la lumière de la stigmatisation structurelle, qui fait référence aux politiques et pratiques institutionnelles qui ont un impact négatif sur les opportunités des personnes atteintes de maladies mentales. Dans le cas présent, la stigmatisation structurelle réduit l'accès aux soins en raison d'une allocation de ressources inadéquate, d'un manque de collaboration intersectorielle et d'intégration des soins, d'attitudes et de pratiques négatives des praticiens de la santé, et d'une surutilisation d'approches coercitives. Nous proposons des stratégies pour réduire les barrières à l’accès liées au système et aux prestataires de soins. / In Canada and elsewhere, the justice system is playing an increasingly important role in the care of individuals with severe mental illness. The role of the justice system as a lever for accessing care is particularly evident in the case of individuals found not criminally responsible on account of mental disorder (NCR). The vast majority of individuals found NCR, who make up the majority of forensic mental health service users, were already known to mental health services. This raises questions about the current capacity of the mental health system to respond to disruptive behaviors and highlights the potential for preventing future justice involvement. This doctoral thesis uses administrative data from the health, justice, and public security sectors for over 1,000 individuals who received a verdict of NCR in Québec. These data are complemented by qualitative interviews with stakeholders. Together, the analysis of this data corpus highlights the barriers to accessing care and service interruptions that individuals with severe mental illness and behaviors perceived as disruptive or dangerous encounter in their care pathway, leading to the risk of judicial involvement. The first article describes trajectories in health services use and prescription drug claims in the year preceding an offense that led to a NCR verdict. The results indicate that, although previous research has shown that over 70% of NCR individuals had already been in contact with mental health services, less than half of NCR individuals had received no consistent care prior to the offense. The results also show that one in five individuals committed the offense less than a week after their most recent mental health contact. Among those who had at least one prescription for an antipsychotic, nearly half were not taking an antipsychotic at the time of the offense. The second article identifies individual and contextual factors that facilitate or hinder access to mental health services in the period prior to the offense. Geographic considerations play a major role in the possibility of accessing and receiving specialized mental health services, beyond individual factors related to needs. Additionally, living with family members decreases the likelihood of seeking mental health services by half and decreases the intensity of specialized mental health service use, even after adjusting for models based on needs. Finally, the third article is based on the analysis of individual interviews and focus groups with 16 individuals with lived experience (peer support workers, family caregivers), practitioners, and administrators. The results highlight how past experiences of stigma, trauma, inefficiency, and discrimination within a hospital-centric system influence the ability of service users and family caregivers to seek and engage with care. Existing access mechanisms during crisis periods, such as police intervention and emergency services, are unacceptable options for service users and their family caregivers and are often considered as a last resort. As a result, service users enter the healthcare system with complex needs that are difficult to address with current clinical knowledge and often result in coercive measures rather than recovery-oriented care. The results can be interpreted in light of structural stigma, which refers to institutional policies and practices that negatively impact the opportunities of people with mental illness. In this case, structural stigma reduces access to care through inadequate allocation of resources, lack of intersectoral collaboration and care integration, negative attitudes and practices of healthcare practitioners, and overreliance on coercive approaches. We propose strategies to reduce system-level and provider-level barriers to access.

Bakgrund: I Sverige vårdas patienter som är dömda till rättspsykiatrisk vård och den begränsade vårdmiljön inom rättspsykiatrin kan ha en negativ effekt på patienternas hälsa. Patienterna har förutom psykiatrisk problematik även ökad dödlighet, risk för somatisk sjukdom och fetma jämfört med övriga befolkningen. Patienterna gör ofta mindre hälsosamma val. Vårdpersonalen ställs ofta inför svårigheter med att utföra sitt vårdande uppdrag och att stärka patienternas hälsoprocesser samtidigt som de ska förhålla sig till säkerhet och patienternas tvångsvård. En ökad förståelse för vårdpersonalens hälsofrämjande arbete behövs för att stärka det hälsofrämjande omvårdnadsarbetet inom rättspsykiatrisk vård. Syfte: Syftet med studien var att belysa hur vårdpersonal uppfattar och erfar hälsofrämjande arbete inom rättspsykiatrisk vård samt främjande och hämmande faktorer för detta arbete. Metod: En kvalitativ metod med induktiv ansats gjordes med fokusgrupper som metod för datainsamling. Två fokusgruppsintervjuer genomfördes. Deltagarna bestod av elva vårdpersonal. Fokusgruppintervjuerna analyserades genom kvalitativ innehållsanalys enligt Graneheim och Lundman.Resultat: Tio underkategorier bildade tre huvudkategorier. En stödjande vårdmiljö, En god vårdrelation och ett tålmodigt arbete samt Att inte alltid kunna hjälpa. Slutligen bildades ett övergripande tema: Ett outtröttligt arbete och engagemang trots hinder och utmaningar.Slutsats: Vårdpersonalens hälsofrämjande arbete sker med hjälp av stöd till fysisk aktivitet, meningsfull aktivitet samt ger kostråd. Detta är av särskild vikt då patienterna ofta har sämre hälsa. Genom att patienterna får välja hälsofrämjande aktivitet förstärks deras empowerment. Nyckeln för att kunna arbeta hälsofrämjande i en begränsad vårdmiljö är att skapa goda vårdrelationer. Vårdpersonal kan själva behöva stöd i att hantera att patienterna trots personalens arbete väljer att göra andra val. / Background: In Sweden, forensic psychiatric patients, undergo treatment in confined environments that may adversely affect their health. In addition to psychiatric issues, patients have increased mortality, a heightened risk of somatic illness, and obesity compared to the general population. Patients often make less health-conscious choices. Nursing staff often confront difficulties in carrying out their caregiving mandates and reinforcing the health processes of patients, simultaneously navigating the imperative of ensuring safety and adhering to compulsory psychiatric care. An increased understanding of the health-promoting endeavours of healthcare professionals is required to fortify health-promotion initiatives within forensic psychiatric care.Aim: The aim of the study was to illuminate how nursing staff perceive and experience health-promoting work within forensic psychiatric care, as well as identifying facilitating and inhibiting factors for this work.Method: A qualitative inductive method used focus groups with eleven healthcare professionals. Interviews analysed qualitatively following Graneheim and Lundman´s method.Results: Ten subcategories formed three main categories: A supportive care environment, A good care relationship and patient-centered approach, and The challenge of not always being able to help. These main categories formed an overarching theme: Relentless work and commitment despite obstacles and challenges. Conclusion: Nursing staff promote health through support to physical activity, meaningful activity and dietary advice. This is crucial for compromised patient health. Empowering patients to choose health-promoting activities is key. Positive care relationships are crucial; inadequate knowledge in forensic psychiatry hinders healthpromotion work. Personnel might need support in handling patients, because despitehard work patients still make other choices.

Syftet med denna studie är att undersöka socialsekreterares och hälso- och sjukvårdskuratorers upplevelser av samverkan mellan rättspsykiatri och socialtjänst vid utslussning av rättspsykiatriska klienter, sett ur ett maktperspektiv. Studiens empiri grundar sig på åtta semi-strukturerade intervjuer, fyra med varje yrkesgrupp, som sedan analyserats med hjälp av en tematisk analys. Studiens slutsats visar på att samverkan mellan socialtjänst och rättspsykiatri påverkas av organisatoriska, ekonomiska och mellanmänskliga faktorer som är svåra att påverka. Studien bekräftar även tidigare samverkansforskning som visar på svårigheter i samverkan när aktörer har olika förutsättningar, uppdrag och mål. Slutsatserna i denna studie leder oss till att förstå intervjupersonernas upplevelser av samverkan mellan rättspsykiatri och socialtjänst. Dessa går att förstås genom: värdet av kompromisser, förståelsen för varandras villkor och behov, upplevelsen av bristande mandat, maktlöshet samt rollförvirring. / The aim of this study is to examine social workers and health care counsellors experiences of cooperation between forensic psychiatry and social services during discharge of forensic psychiatric clients, seen from a power perspective. The study's empiricism is based on eight semi-structured interviews, four with each professional group, which were analyzed using a thematic analysis. The study's conclusions show that collaboration between social services and forensic psychiatry is affected by organizational, financial and inter personal factors that are difficult to affect. The study confirms previous collaboration research that shows difficulties in collaboration when actors have different conditions, assignments and goals. The conclusions of this study lead us to understand that the interviewees experiences of collaboration between forensic psychiatry and social services can be understood through: the value of compromise, the understanding of each other's conditions and needs, the experience of a lack of mandate, powerlessness and role confusion.

Considerando que estamos vivendo em São Paulo e em todos os Estados do Brasil, um brutal estado de insegurança pública, vemos o crime de seqüestro (tanto na sua modalidade clássica de manter a vítima em cativeiro por período de tempo variável até o pagamento de resgate, quanto à modalidade conhecida como \"seqüestro-relâmpago\", no qual a vítima fica em poder dos criminosos por poucas horas, enquanto eles agem sobre caixas eletrônicos de bancos e as ameaçam de várias maneiras) atingir um grande número de pessoas com conseqüências graves para o desempenho de suas funções existenciais pós-seqüestro. Este trabalho mostra, através de Entrevistas Estruturadas e Escalas de Avaliação, que o grau de magnitude do Transtorno de Estresse Pós-Traumático que acomete vítimas de ambos os tipos de seqüestro atinge picos suficientemente elevados e que devem receber maior atenção tanto em nível de Saúde Pública quanto Segurança Pública. / Considering that we are living in Sao Paulo and all others States of Brazil, a brutal state of public unsafeness, we see the kidnapping crime (not only in its classical modality of keeping the victim in captivity for a variable period of time until the rescue payment, but also in the modality known as \"lightning-kidnapping\", in which the victim remains under the criminal´ s arrest for few hours, while they act on cash machines and threaten the victims) reaching a great number of people with serious consequences for the performance of their post-sequestration existential functions. This work shows that the magnitude level of the Post-Traumatic Stress Disorder that attacks kidnapping victims reaches sufficiently high peaks, that must receive more attention, not only in terms of Public Health but also Public Security.

Considerando que estamos vivendo em São Paulo e em todos os Estados do Brasil, um brutal estado de insegurança pública, vemos o crime de seqüestro (tanto na sua modalidade clássica de manter a vítima em cativeiro por período de tempo variável até o pagamento de resgate, quanto à modalidade conhecida como \"seqüestro-relâmpago\", no qual a vítima fica em poder dos criminosos por poucas horas, enquanto eles agem sobre caixas eletrônicos de bancos e as ameaçam de várias maneiras) atingir um grande número de pessoas com conseqüências graves para o desempenho de suas funções existenciais pós-seqüestro. Este trabalho mostra, através de Entrevistas Estruturadas e Escalas de Avaliação, que o grau de magnitude do Transtorno de Estresse Pós-Traumático que acomete vítimas de ambos os tipos de seqüestro atinge picos suficientemente elevados e que devem receber maior atenção tanto em nível de Saúde Pública quanto Segurança Pública. / Considering that we are living in Sao Paulo and all others States of Brazil, a brutal state of public unsafeness, we see the kidnapping crime (not only in its classical modality of keeping the victim in captivity for a variable period of time until the rescue payment, but also in the modality known as \"lightning-kidnapping\", in which the victim remains under the criminal´ s arrest for few hours, while they act on cash machines and threaten the victims) reaching a great number of people with serious consequences for the performance of their post-sequestration existential functions. This work shows that the magnitude level of the Post-Traumatic Stress Disorder that attacks kidnapping victims reaches sufficiently high peaks, that must receive more attention, not only in terms of Public Health but also Public Security.

Depuis les années 1990, un nombre grandissant d’accusés sont déclarés non criminellement responsables pour cause de troubles mentaux au Canada (NCRTM). Si certains craignent que ce verdict représente une échappatoire à la punition et libère des individus dangereux en collectivité, d’autres s’interrogent à savoir si cette défense n’occasionnerait pas plus de contrôle qu’une peine dans le système pénal traditionnel. Certains questionnent également la capacité des Commissions d’examen à prendre des décisions qui s’écartent de la rationalité du système punitif. Objectif : Cette étude a pour but de comparer la supervision imposée aux accusés NCRTM à celle des accusés coupables et responsables (CR). Cette comparaison cherche à observer les particularités des trajectoires (durées de supervision et de détention et présence de détention dans le suivi) de ces populations, dans trois provinces canadiennes (Québec, Ontario, Colombie-Britannique) entre 2000 et 2008. Deux sources de données ont été utilisées, soit celle du National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada pour les accusés NCRTM et celle de l’Enquête sur les tribunaux de juridiction criminelle de Statistiques Canada pour ceux déclarés CR. Résultats : Les résultats des régressions de Cox et logistiques indiquent que les accusés NCRTM sont près de trois fois et quatre fois moins susceptibles d’être libérés rapidement de supervision et de détention et sont cinq fois plus susceptibles d’être détenus que les accusés CR. Des différences importantes sont présentes dans les pratiques des provinces, mais de manière significativement plus importante chez les accusés NCRTM. / Since the 1990’s, the number of individuals found not criminally responsible on account of mental disorder has increased in Canada. However, the NCRMD verdict remains controversial. While some fear that the verdict is a loophole and releases dangerous individuals in the community, others suggest that this defense could cause more control than a sentence in the criminal justice system. Some also question the ability of Review Boards to leave aside the punitive rationale in the decision-making process. Objective: This study examines the supervison practices imposed to NCRMD accused by comparing them with those applied to offenders found guilty and responsible (GR). This comparison aims to highlight the specificities these two populations’ trajectories (length of supervision, length of detention and presence of detention in follow-up), in three Canadian provinces (Quebec, Ontario and British Columbia) between 2000 and 2008. Two datasets were used. The first comprises individuals found NCRMD (n = 1794) and comes from the National Trajectory Project of Individuals Found Not Criminally Responsible on Account of Mental Disorder in Canada. The second comprises GR offenders (n = 320,919) and comes from Statistics Canada's Criminal Court Survey. Results: The Cox and logistic regressions results show that NCRMD individuals are almost three times and four times likely to be released from legal supervision and detention respectively compared to GR offenders, and are five times more likely to be detained during follow-up. Provincial differences were also observed, theses disparities being significantly greater among NCRMD individuals.

L’autorisation judiciaire de soins (AJS) est utilisée dans le domaine de la santé mentale afin de permettre le traitement d’une personne alors que celle-ci est jugée inapte à consentir à ses soins et qu’elle les refuse de manière catégorique. L’utilisation de cette mesure d’exception est en augmentation à travers le monde (Rugkåsa et Burns, 2017), malgré ses résultats variables en termes retombées clinique, sociale et économique et ses impacts négatifs importants sur la vie de la personne qui en est visée (Kisely, Campbell et O'Reilly, 2017). La dimension coercitive inhérente à l’AJS complexifie le travail auprès de cette clientèle, alors que l’infirmière est appelée à promouvoir le rétablissement et l’autodétermination de la personne tout en devant lui imposer un traitement non désiré (Corring, O'Reilly, Sommerdyk et Russell, 2018). La relation thérapeutique étant reconnue comme étant la pierre angulaire des soins infirmiers de santé mentale en apportant de nombreux bénéfices pour la personne soignée, il est essentiel de comprendre l’influence de l’AJS sur celle-ci. À ce jour, peu d’études ont porté sur la relation thérapeutique dans le contexte des AJS, ne permettant pas une compréhension approfondie de ce sujet. Guidée par la théorie du Recovery Alliance Theory (Shanley et Jubb-Shanley, 2007), cette étude qualitative descriptive avait pour but de décrire la relation thérapeutique en contexte d’AJS selon la perspective d’infirmières et de personnes vivant avec un problème de santé mentale. Des analyses secondaires ont été réalisées à partir d’entrevues individuelles auprès d’infirmières (n=9) et de personnes étant ou ayant été sous AJS (n=6) provenant de trois instituts en santé mentale selon la méthode de Miles, Huberman et Saldaña (2020). La relation thérapeutique a été décrite comme fondamentalement ancrée dans une inégalité de pouvoir qui est amplifiée par l’AJS. Les résultats mettent en lumière les liens complexes existant entre la relation thérapeutique et l’AJS et font ressortir la divergence des perspectives des infirmières et des personnes quant à la possibilité de développer cette relation. Les personnes sous AJS ont rejeté l’idée de pouvoir développer une relation de confiance dans ce contexte, décrivant des interactions superficielles, utilitaires et unidirectionnelles avec les infirmières. La perspective des infirmières a montré que celles-ci croient en la possibilité de développer une relation thérapeutique, malgré les contraintes qui leur sont imposées par l’AJS. En effet, celles-ci engendrent un conflit au niveau des différents rôles que les infirmières doivent intégrer dans leur pratique, l’un étant guidé par leur responsabilité légale et l’autre par leur pratique professionnelle. À la lumière de ces résultats, les infirmières devraient être sensibilisées à la perspective des personnes sous AJS, tout en bénéficiant d’un soutien pour les accompagner dans la gestion de cette mesure amenant une complexité à leur travail et au développement de la relation thérapeutique. D’autres études sont nécessaires afin d’explorer des pistes de solution pour permettre à l’infirmière et à la personne de développer une relation thérapeutique en dehors des contraintes imposées par l’AJS. / Involuntary treatment orders (ITO) are used in the mental health field to allow for treatment of individuals living with a mental illness considered incapable of giving consent and who are actively refusing treatment. The use of this exceptional measure is increasing around the world, with a presence in 75 different jurisdictions (Rugkåsa et Burns, 2017), despite its conflicting results in terms of clinical, social and financial outcomes and its negative impacts on the patients (Kisely et al., 2017). The coercive dimension inherent to the ITO poses many challenges for the nursing practice, as nurses must promote recovery and self-determination while having to impose an unwanted treatment (Corring et al., 2018). Since the nurse-patient therapeutic relationship is the cornerstone of mental health nursing, allowing many benefits for the patient’s health and well-being, it is essential to better understand the influence the ITO has on this relationship. Few studies have been carried on the therapeutic relationship in the context of ITOs, which does not allow for a comprehensive understanding of the subject. Guided by the Recovery Alliance Theory (Shanley et Jubb-Shanley, 2007), this study aimed to describe the therapeutic relationship in the context of ITOs as reported by nurses and individuals living with a mental illness. Secondary data analysis of qualitative data was performed from individual interviews with nurses (n=9) and patients who are or have already been on an ITO (n=6). Data were collected from three mental health and forensic psychiatric institutes and were analyzed using a process of content analysis (Miles et al., 2020). The therapeutic relationship was described as fundamentally imbedded in a power imbalance amplified by the ITO. Results highlight the complex links between the therapeutic relationship and the ITO and the divergent perspectives of nurses and patients on the possibility to develop this relationship. Patients rejected the possibility of developing a trusting relationship in this context, describing interactions with nurses as superficial, utilitarian, and unidirectional. The nurses’ perspective showed that nurses do believe in the possibility to build a therapeutic relationship despite the challenges caused by the ITO. Indeed, the ITO generates conflict between the different roles of the nurses, one being guided by their legal responsibility and the other by their professional practice. In light of these results, nurses should be made aware of the perception of patients on ITOs, while benefiting from support to assist them in the management of this measure which brings many challenges to their practice and to the development of the therapeutic relationship. Further studies should explore possible solutions to allow the nurse and the patient to develop a therapeutic relationship outside the constraints of the ITO.