A Critical Realist Informed Thematic Analysis: Families’ Experience of the Process of Adjustment When a Family Member Is in a Forensic Mental Health Hospital

The experience of families who have a member in a forensic mental health hospital (FMHH) is a neglected area of research. It is understood that these families are a vulnerable population and face additional challenges e.g. violent behaviours, criminal justice system contact, to that of “carers” who care for a person with a mental health difficulty. Families’ experience of the process of adjustment when they have a member in a FMHH is a novel area of research, which this qualitative study explored. Eleven family members with a relative in a FMHH were interviewed. A Critical Realist informed Thematic Analysis was used to analyse the interviews. Two global themes emerged; “negotiating systems” and “family processes”. ‘Adjustment theories’, ‘systems theory’ and ‘family recovery’ were used as conceptual frameworks, which have been applied to “carers” who care for a person with a mental health difficulty, to understand the findings. Families are traumatised. The unexpected transitions of a member developing a mental health difficulty, violent behaviours and subsequent admission to a
FMHH, result in a fragmented family. Families adjust to such change and form strategies to remain connected and cohesive, sometimes unhelpfully. Families are challenged by coming into contact with dominating, powerful and intrusive systems whilst supporting their family member in to appropriate mental health services and admission to a FMHH. Families feel disempowered and disregarded, resulting in a lack of trust of the FMHH. Families are resourceful in using their personal resilience and seeking external support to adjust to these challenges. However, when families seek support from services for themselves it is unavailable, inaccessible and/or inappropriate. Throughout the Service Users’ journey, families need to be; recognised, valued and supported. The study presents direct implications for research, policy and
practice.