An exploration of service users' experiences of a low secure forensic mental health service

摘要

This is an exploratory study of the experiences of service users in forensic mental health settings, including how service users make sense of these experiences and their link to identity. Current research into forensic mental health services is very limited (Coffey,2006). Research has focussed on describing specific events but has not explored how service users have experienced their environment, relationships, and treatment. The information that has been gathered has focused on medium and high secure settings with very little research having been conducted in low secure setting settings. There was therefore a need for further research to inform clinicians and influence their practice so as to reduce psychological distress and risky behaviour, and to work towards recovery and reintegration into the community. Semi-structured interviews were conducted with six service users from a low secure forensic mental health service to explore experience. These accounts were analysed using Interpretative Phenomenological Analysis (Smith, 1995) to create themes that reflected experiences, understanding of these experiences and identity. Individual cases and group themes have been presented. Service users described a range of experiences such as feeling vulnerable, experiencing life as having been interrupted and valuing positive experiences with other people. Their understanding of these experiences fell into four categories: biological, psychosocial stress, behavioural and experience as being senseless. Participants used a range of ways from each category to make sense of their experience and these were sometimes contradictory. There was also a theme of participants trying to make sense of other people's thinking. Each participant had a combination of ways of understanding that was individual to them. Participants evaluated their character, ability and affiliation to help define their identity. These evaluations had an interpersonal aspect. The findings of the study have been discussed in relation to research from settings with different levels of security. They have also been discussed in relation to social psychological frameworks such as Symbolic Interaction (Blummer, 1938,1969), Social Representation Theory (Moscovici, 1973) and Social Identity Theory (Tajfel and Turner, 1986) to help understand meanings and how identity is shaped by experience. Clinical implications have been discussed. These include increasing opportunities for meaningful activities and relationships, and working with service users to help them to find ways of coping with their internal experiences, to feel empowered and take an active role in their recovery, and to build positive identities.