| Abstract | Introduction:
Long stay care in forensic mental health settings is planned for under the Care Programme Approach. Originally designed for community patients, forensic patients in custodial secure hospitals are treated with the same care planning framework. This is despite the very specific treatment conditions and legal status of forensic mental health patients. This leads to non-specific care, often void of efficacy, and ineffective care planning frameworks leads to the phenomena of the long stay patient. This study aimed to explore phenomenologically, the lived experience of long stay patients, and the staff that treat them, to better understand the forensic secure setting and related care planning in the UK. Method:
15 patients were recruited from a medium secure unit, and 11 staff who delivered care and who knew those patients, often for many years, were interviewed with an insider researcher framework where the researcher also worked with both the patients and staff. Data was analysed using Interpretative Phenomenological Analysis. Findings:
Results explore the lived experience of both staff and the long stay forensic patients they treat. Patient Superordinate themes include: “Control as a mechanism of selfpreservation”, “The Outside World as the Feared Place,” “The Need for Leverage in Relationships” and “Hiding the Internal Reality from Others.” Staff Superordinate themes include: “Acceptance of Futility,” “Becoming More than a Therapeutic Relationship,” “Firefighting rather than Treating,” “Realisation of the Challenge” and “Acting as means of Self Preservation.” Discussion:
An exploration of the findings is discussed, in reference to extant literature and theory. Practical implications rooted in phenomenology offer phenotypes for advancing clinical
practice, care provision, education and training, when working with this highly specialised, and growing subsection of forensic patients. Conclusions:
With little in the way of specialised forensic care, apart from the physical forensic secure hospital and adjunct legal mechanisms, long stay patients are a growing portion of the overall forensic patient population. This phenomenological exploration of lived experiences, sheds light on why and how this may be the case and offers a phenomenological reframing of what forensic care may offer patients, and how staff can adapt to these challenges. |
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