Ageing in forensic psychiatric secure settings: the voice of older patients

Abstract

Older patients account for around 20% of the population in secure forensic psychiatric services in the UK. However, little qualitative research has investigated the experience of ageing in secure settings. This study aimed to gather the individual views of a sample of patients over 50 years old in the UK at different levels of security. Fifteen participants were selected and underwent one-on-one qualitative interviews. The interviews were analysed through thematic analysis, which generated seven themes: Self-agency, activities, social life, practical matters, recovery, physical health and service improvement. Study findings highlighted the complexity of ageing in secure settings. Despite the positive feedback reported in aspects such as physical health care, education opportunities, staff and support of religious practices, participants experienced added barriers to recovery, caused by social isolation/withdrawal and activities/treatment that did not respond to their complex age-related needs, generating poor motivation to engage. Our findings call for the development/implementation of programmes tailored to the unique needs of older patients. This process requires an active involvement of the primary stakeholders and further patientcentred research.

The characteristics and needs of older forensic psychiatric patients: a cross-sectional study in secure units within one UK regional service

“…This study is reported according to the principles of the STROBE Statement (Von Elm et al, 2014). It is part of a larger project entitled 'The characteristics, needs and individual experience of older forensic psychiatric patients: A cross-sectional study in three secure units within one regional service', which also comprised two qualitative studies previously published in this journal (Di Lorito, Dening, & Völlm, 2019;Di Lorito, Dening, & Völlm, 2018).…”

Growing older in secure mental health care: the user experience

“…Di Lorito et al (2018) in a qualitative study that included service users from all levels of secure settings found that new activities to keep the mind busy, and ageinclusive activities were important for participants. Yorston and Taylor (2009) in their research in a high secure setting, also found that peace and quiet as well as leisure and education opportunities were important to older forensic in-patients in high security, but found in addition that the admission of younger patients to an older ward altered and increased restrictions.…”

“…Exploratory qualitative studies with small numbers of patients in forensic hospitals in Italy (Di Lorito et al, 2017) and Belgium (De Smet et al, 2015) suggested that older forensic in-patients were predominantly positive about the care provided. In a recent UK-based study, Di Lorito et al (2018) argued there were unique challenges to recovery for older service users including lack of awareness of older age issues among staff.…”

Mental health and offending in older people: Future directions for research

“…Prisoners suffering from cognitive impairment did not necessarily seek help or consider their quality of life to be affected. Di Lorito, Dening, and Völlm () compared nine studies of older prisoners with similar studies in the community and concluded that the prevalence for dementia in prison studies was in the region of 3.3% and similar to community prevalence but studies indicated that cognitive impairment was more widespread. A link with poor physical health has been highlighted by a study of 310 prisoners in the United States (Ahalt et al, ) who found cognitive impairment to be associated with multiple emergency room visits, hospital admission, and repeat arrests over a 6‐month follow‐up period.…”