Patient perspectives on general practitioners in forensic psychiatric wards

Forensic psychiatric patients experience high rates of preventable physical illness. Integrating primary care within forensic settings may help address this gap, yet little is known about how patients experience such services.

To explore how forensic psychiatric patients experienced an on-ward general practitioner (GP) service and how these experiences shaped engagement with integrated care.

We conducted a qualitative interview study with 14 patients from two Danish medium-secure forensic psychiatric wards. Semi-structured interviews were analyzed using reflexive thematic analysis to identify key patterns of meaning.

Patients generally perceived the GP service as relevant and valued its distinct somatic focus, which countered perceptions that physical symptoms were overlooked by psychiatric staff. The GP's proximity and accessibility encouraged consultations, and the outsider role provided a less custodial relationship. However, engagement was conditional and barriers were experienced, such as limited continuity, perceptions of redundancy due to existing services, and discomfort during intimate examinations, especially when staff were present or of the opposite sex.

While broadly welcomed, GP engagement remained reactive and dependent on trust and privacy. These findings suggest that future integrated care models may benefit from considering relational continuity, sensitive examination practices, and structures supporting preventive somatic care.