Taking parents seriously: The experiences of parents with a son or daughter in adult medium secure forensic mental health care

Tilting at Windmills - A Qualitative Study about Family Caregiver Interactions and Perceptions in Forensic Mental Health Care

In forensic mental health care (FMHC), family caregivers perceive themselves as burdened in their relationships with the service user (the family member with mental illness) and by difficult collaboration with healthcare professionals (HCPs). There is a political objective to involve this group in the care and treatment of the service user in mental health care. To improve family caregiver involvement in care and treatment in FMHC, research about their perceptions is needed. This study aims to explore family caregivers' perceptions of their interactions with the service user and HCPs. The method used was qualitative. Semi-structured, in-depth interviews with 12 family caregiver participants were carried out and analyzed thematically. The analysis resulted in three interrelated main themes: Strategies to normalize everyday living; Distrust of the quality of care; and Loss and grief. Family caregiver feelings of loss and grief may be suppressed, which additionally could prevent them from supporting the service user.

Experiences of family members of relatives admitted as state patients in a psychiatric hospital

Background

Family members play an important role in caring for state patients during their admission to a psychiatric hospital. They receive limited support from the multidisciplinary team because they do not have a relationship that will promote the families to verbalise their thoughts, rather the interaction that the multidisciplinary team and family members share is about the admitted state patient.

Aim

This article explored and described the experiences of family members who have a relative admitted as a state patient in a psychiatric hospital. Based on the findings, specific recommendations were provided to facilitate the mental health of state patients' family members in the future.

Setting

The study was conducted in participants' homes; only one interview took place in the psychiatric hospital when the family member came to meet the multidisciplinary team.

Methods

The study employed a qualitative, exploratory and contextual research design. Family members' lived experiences were explored using in-depth phenomenological interviews and later analysed.

Results

The findings indicated family members experienced negative feelings, a sincere desire to support their relatives and a great need to share information and knowledge about mental illness.

Conclusion

The study indicated that state patients' family members' mental health should be focused on to improve their understanding of mental illness.

Contribution

The findings of this study call for collaboration between the family members, the police and multidisciplinary teams from the hospitals, the mental health awareness and counselling for families.

Experiences of family caregivers in forensic mental health care-A qualitative evidence synthesis

WHAT IS KNOWN ON THE SUBJECT

Internationally, research and policy agendas recommend that family caregivers of service users in mental health care be involved in care and treatment, to support the service user's recovery process. Family caregivers of service users in mental health care are often highly burdened. There is a lack of research-based knowledge about the experiences of family caregivers of service users in forensic mental health care (FMHC) and their involvement in care and treatment.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

This study indicates a persistent caregiver presence and/or caregiver advocacy in regard to care and treatment of the service user in FMHC. This study indicates that health care professionals (HCPs) might play a role in eliciting a persistent caregiver presence and/or caregiver advocacy.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

HCPs need to develop their collaborative skills and be more willing to listen to and understand caregivers' persistent presence and/or advocacy. HCPs need to be more skilled to understand caregivers' and families' living with the complexities of mental illness and offence. HCPs are encouraged to adjust the involvement of family caregivers in care and treatment to FMHC.

ABSTRACT

Introduction There is a lack of research about experiences of family caregivers of service users in forensic mental health care (FMHC) and their involvement in care and treatment. Research shows that caregivers are burdened. Further knowledge is required, to provide a foundation for improving clinical practice. Aim To review research literature, to investigate existing knowledge about caregiver experiences and, secondly, caregivers' experiences of facilitators and barriers related to their involvement in care and treatment. Method Qualitative evidence synthesis undertaken in a thematic synthesis of thirteen peer-reviewed studies. Results The analysis identified three descriptive themes: violence against family; a great burden of responsibility; and difficult collaboration, together with an additional three analytical themes: bearing witness; persistent presence; and advocacy becomes necessary. Discussion Persistent caregiver presence and/or caregiver advocacy may be elicited by health care professionals' (HCPs') exclusion of caregivers from care and treatment. Caregivers' feelings of guilt in relation to the service user's offence may play an additional role in persistent presence and advocacy and, therefore, in HCPs' exclusion of them. Implications for Practice HCPs need to develop their collaboration with caregivers by their willingness to listen to caregivers to understand emotional complexities within families experiencing mental illness and offence.

"It's still our child". A qualitative interview study with parent carers in forensic mental health

The purpose of this study was to explore the experiences and perceptions of parents in forensic mental health services with regard to their cooperation with healthcare professionals and their role as parent carers. 15 participants were interviewed using qualitative, in-depth interviews and transcripts were analysed thematically. The identified themes were 'Medical dominance', 'Interactions with healthcare professionals', and 'Advocating for their daughter/son'. The themes were associated with the overall theme 'perceived impact on the parents' everyday lives'. The results suggest that parent carers perceive a malalignment between the institutional medicalised treatment focus and the need for an integrated holistic approach, which would include them as partners.

Voices to be heard: Understanding family perspectives in forensic care trajectories

INTRODUCTION

De-institutionalization of psychiatric care has greatly increased the role of family members in the recovery pathways of Persons labeled as Not Criminally Responsible (PNCR). However, the role of family members in supporting PNCR in forensic psychiatric care remains understudied. Scarce evidence indicates that PNCR have to deal with stigma and endure specific burdens (i.e., symptom-specific, financial, social, and emotional). Recovery-focused research showed that recovery in both persons with a severe mental illness and family members develop in parallel with each other and are characterized by similar helpful principles (e.g., hope and coping skills). As such, the recovery pathways of PNCR often goes hand in hand with the recovery pathway of their family members. During the family recovery process, family members often experience not being listened to or being empowered by professionals or not being involved in the decision-making process in the care trajectory of their relative. Therefore, the aim of this study is to capture how family members experience the care trajectories of their relatives, more specifically by looking at family recovery aspects and personal advocacy of family members.

METHODS

Semi-structured interviews were conducted with 21 family members of PNCR from 14 families. A thematic analysis confirms that family members suffer from stigma and worry significantly about the future of their relative.

RESULTS

Regarding the care trajectory of PNCR, family members experienced barriers in multiple domains while trying to support their relative: involvement in care and information sharing, visiting procedures, transitions between wards, and the psychiatric and judicial reporting by professionals. In addition, family members emphasized the importance of (social) support for themselves during the forensic psychiatric care trajectories and of a shared partnership.

DISCUSSION

These findings tie in with procedural justice theory as a precondition for family support and family recovery within forensic psychiatric care.

Carers' experiences of involuntary admission under mental health legislation: systematic review and qualitative meta-synthesis

BACKGROUND

Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers' experiences of and views about assessment for involuntary admission and subsequent detention is crucial to efforts to improve policy and practice.

AIMS

We aimed to synthesise qualitative evidence of carers' experiences of the assessment and detention of their family and friends under mental health legislation.

METHOD

We searched five bibliographic databases, reference lists and citations. Studies were included if they collected data using qualitative methods and the patients were aged 18 or older; reported on carer experiences of assessment or detention under mental health legislation anywhere in the world; and were published in peer-reviewed journals. We used meta-synthesis.

RESULTS

The review included 23 papers. Themes were consistent across time and setting and related to the emotional impact of detention; the availability of support for carers; the extent to which carers felt involved in decision-making; relationships with patients and staff during detention; and the quality of care provided to patients. Carers often described conflicting feelings of relief coupled with distress and anxiety about how the patient might cope and respond. Carers also spoke about the need for timely and accessible information, supportive and trusting relationships with mental health professionals, and of involvement as partners in care.

CONCLUSIONS

Research is needed to explore whether and how health service and other interventions can improve the involvement and support of carers prior to, during and after the detention of family members and friends.

A Matter of Trust and Distrust: A Qualitative Investigation of Parents' Perceptions About the Use of Mechanical Restraint on Their Adult Children in a Forensic Psychiatric Setting

INTRODUCTION

Increased knowledge about forensic psychiatric patients' relatives' perceptions in regard to the use of mechanical restraint (MR) is necessary, if clinical practice is to be improved and to achieve a reduction in the use and frequency of MR. However, a specific knowledge deficit about relatives' perspectives on the use of MR limits the evidence base considerably.

AIM

The aim of this study was to investigate the perceptions of MR held by relatives of forensic psychiatric patients' including factors impacting its use and duration.

METHOD

Qualitative interviews were conducted with 15 parents of patients within a forensic psychiatry setting and thematically analyzed.

FINDINGS

Two main themes were identified, namely, "care and protection" and "inclusion and involvement," and one subtheme, "information." These themes revealed the framework used by parents to construct a sense of "trust or distrust" about the ability of staff to provide adequate and safe care for their adult children in the forensic psychiatric setting.

CONCLUSION

Some parents in this study considered that forensic psychiatric staff used MR as a necessary protection. However, most parents held strong negative perceptions regarding the use of MR and the quality and safety of care provision. It is apparent that parents in this study believed they should be included and involved in the care in situations associated with the use of MR, because they considered that this could reduce its use. Further research is required to target interventions to reduce the use and duration of MR episodes and to improve clinical practice in forensic psychiatry.