Older adult forensic mental health patients’ views on barriers, facilitators and ‘what works’ to enable better quality of life, health and wellbeing and to reduce risk of reoffending and harm to self and others

Abstract

Introduction Research evidence that can inform service provision and treatment requirements for older (aged 55 years and above) forensic mental health patients is lacking, particularly that which is based on patients’ own preferences and experiences. This study aimed to gain an effective understanding, based on patients’ perspectives, of the service provision in forensic mental health inpatient and community services; investigating what could improve or hinder their quality of life, health, wellbeing, progress, and recovery. Method A qualitative approach was taken to examine the accounts of patients. Interviews (semi-structured) with 37 older forensic mental health patients either residing in secure units or in the community were conducted. Data were analysed using thematic analysis. Results Two global themes: ‘Enablers and Facilitators’ and ‘Threats and Barriers’ were identified; these were at three levels: environmental, interpersonal and individual. Results indicated that: the physical and social environment should be adapted to accommodate the needs of older patients (e.g., for physical health, frailty, and poor mobility); prosocial interpersonal relationships with family, other patients and staff needed to be promoted; and hope and positive future focus needed to be embedded to aid recovery. Discussion Findings suggest that multilevel and comprehensive support, that is individualised, is required for this population. This is needed so that: patients are residing in suitable environments that address their physical, mental, and criminal justice needs; social connectedness forms part of their recovery journey; and hope, purposefulness and personal agency is facilitated.