Exploring ‘Long-Stay’ Male Service Users’ Perception of their Physical Healthcare in Forensic Mental Health Services

Aims: To explore the experiences of Service Users detained in a High Secure Forensic Mental Health Service relating to their physical healthcare, including their attitudes toward physical wellbeing, and access and quality of service provisions.

Background: Several factors affect the physical wellbeing of those detained in mental health services or forensic services. People with a severe and enduring mental health diagnosis are more likely to have physical health comorbidities, often because of antipsychotic medication. Those in forensic services are more likely to have greater physical health needs due to historic trauma and social factors and restricted access to health promoting resources once detained which can worsen with longer detentions. It is therefore important to explore and understand the needs of this group as they will experience a greater number of mediating factors that influence physical health.

Methodology: Nine semi-structured interviews were conducted with adult males detained within secure services for over eight years who currently resided in a high secure service. A critical realist epistemological framework was adopted to explore and generate themes.

Results: A thematic analysis identified three main themes; ‘The Meaning of Wellbeing’, ‘Being in a High Secure Forensic Environment’, and ‘The Role of Staff and the System’. The largest theme was the secure environment and participants' views on restrictions and impositions to their daily life. Participants were thoughtful about aspects that impact their health such as medication, individual responsibility, and diet. All agreed they were offered activities and access to healthcare; however motivation and staff availability could affect uptake amongst participants. These are explored further within the research.

Conclusion: The themes offered an opportunity to hear and understand service user’s perspectives on an area that is becoming more considered. Recommendations discussed include integration of physical health and mental health services, staff training and employment of psychological approaches to physical healthcare.