Rethinking networks through relatedness - a qualitative study among inpatients in forensic psychiatry.

Background: Recovery-oriented approaches in forensic psychiatry increasingly emphasize the importance of social relationships. However, research and practice have primarily approached significant relationships through a family-caregiver lens leaving less knowledge about the broader range of relationships that may be meaningful to patients. Drawing on the concept of relatedness, this study explores how forensic psychiatric inpatients understand and negotiate their networks of significant relations during long-term admission. Methods: A qualitative study was conducted in two medium secure forensic psychiatric units in Denmark. Twenty-four inpatients participated in semi-structured interviews supported by sociograms, which enabled participants to map and reflect on their social networks. Data were analyzed using a combination of descriptive analysis of sociograms and reflexive thematic analysis of interview transcripts. Results: Participants described their networks as fluid and context-dependent, encompassing not only biological relatives but also peers, former partners, professionals, and symbolically or digitally mediated relations. Three overarching themes were identified: (1) temporal trajectories, highlighting how relationships were shaped by past ruptures, present functions, and future hopes; (2) forms of relational presence, including emotional and symbolic connections as well as ambivalence; and (3) relational dynamics and agency, reflecting how participants actively maintained, redefined, or distanced themselves from relationships under institutional constraints. Relationships were characterized by both significance and fragility, with participants navigating tensions between connection, burden, and self-preservation. Conclusions: The findings challenge narrow conceptions of informal caregiving in forensic psychiatry by demonstrating that patients' significant networks extend beyond family-based models. Adopting a relatedness perspective highlights the need for clinical practices that recognize diverse and patient-defined relationships, including symbolic and context-specific forms of connection. Tailoring involvement strategies to patients' own relational priorities, while remaining attentive to ambivalence and potential burden, may support more nuanced and person-centered approaches to recovery in forensic psychiatric care.