Background: Patient participation is regulated both in legislations and in national healthcare guidelines, and the model “shared decision making” has been proven as successful in general healthcare. Patient participation thus seems to be an established concept in healthcare. However, in forensic psychiatric settings, a context with inherent coercive measures, is it possible to conclude that patient participation is conceptualized in the same way as other healthcare disciplines?

Purpose: The purpose of this study is to describe patient participation as experienced by caregivers in forensic psychiatric care.

Method: Data was collected through interviews from a reflective lifeworld perspective with mental healthcare workers and nurses (N = 12), and then analyzed with a phenomenological meaning analysis according to Dahlberg.

Results: The caregivers’ situation is complex, where they are expected to take responsibility for patient participation while at the same time taking responsibility for the rules and routines within the care setting. This is further complicated by the juridical implications within forensic psychiatry. Taking this responsibility is an act of balance were the caregiver focuses on establishing a caring relation and to help the patient to make sense of the care situation, rather than contribute to participation in the form of shared decision making. Participation is dependent on the caring relationship.

Conclusion: Forensic psychiatry uses the same terminology as the rest of the healthcare system, even though the environment differs significantly from other parts of the healthcare system due to the ingredient of compulsion. Without help to understand how patient participation can be conceptualized in this context, participation is just a word, a facade and more a limitation for the caregiver than a help in the quest for a successful care. The caring relationship is suggested to be the key to patient participation in forensic psychiatry.