Purpose: The overall purpose of this dissertation is to describe how patient participation can be understood in the context of high-security care in forensic psychiatry, where individuals are subjected to compulsory care.

Design and method: The dissertation is primarily based on a phenomenological foundation, employing a reflective lifeworld approach. Three studies were conducted using interviews, and one study utilized questionnaires with descriptive and comparative statistics.

Main result: In many ways, both patients and staff share a consensus regarding patient participation in forensic psychiatric care. From their respective perspectives, similar obstacles and challenges are described, while good care and the experience of participation are strongly linked to what occurs within the caring relationship. However, it cannot be ignored that participation is not solely about good treatment and meaningful relationships. Forensic psychiatric care is carried out under compulsion within a legal system that is difficult for patients to understand and may be perceived as unjust. Participation must therefore be understood from a broader perspective than just everyday care, as everyday care is part of a larger care process.

Conclusions: Caregivers and patients associate patient participation in a high-security forensic psychiatric environment with significant caring relationships. A strong caring relationship seems to partially compensate for many situations characterized by non-participation. The studies suggest that staff need support in understanding the complexities of forensic psychiatry in order to better support patients throughout the care process. Therefore, a clinical implication is to help caregivers understand the forensic psychiatric system themselves so that they can explain it to patients and engage in discussions about jurisprudence related to forensic care.