Older adult forensic mental health patients: defining needs, barriers, facilitators and 'what works' to enable better quality of life, health and wellbeing and to reduce risk
Creators: name: Tomlin, Jack
name: Griffiths, Chris
name: Völlm, Birgit
name: Dening, Tom
name: Yates, Jennifer
name: Walker, Kate
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Medicine and Health Sciences

description: Forensic psychiatric services work with people with mental illness and who pose a risk to themselves or others deemed to be sufficiently high to require confinement to secure facilities, or risk assessment and management in the community (JCPMH, 2013). Older forensic psychiatric patients (defined as aged 55 or over) typically have histories of childhood neglect/abuse, substance abuse, poor health self-management, psychiatric admission, homelessness, violence, cognitive difficulties, mobility problems, sensory impairment, and chronic physical illness (Lightbody et al., 2010; Di Lorito et al. 2018). This means they have complex needs and risks. The remit of forensic psychiatric services is to respond to patients individual treatment needs to enable recovery and better levels of health, wellbeing and quality of life and lower levels of risk to themselves and others (Anderson, 2011). The ability of services to meet these needs requires further investigation (O Sullivan &amp; Chesterman, 2007; Coid et al. 2011). When compared to younger adults forensic inpatients, older adults did not show improvements at discharge on measures of severe disturbance, emotional well-being, or risk; and they experience a decline in personal wellbeing (Griffiths, 2018) - despite longer periods of hospitalisation (Völlm et al., 2017). It is important that psychiatric services fit individual needs to enable progression, recovery and better levels of health, wellbeing and quality of life (Anderson, 2011). Unmet needs mean some patients remain in a higher level of security than is appropriate for their risk level (Yorston, 1999). Research is required to understand patient needs and to enable services meet these needs. The overall aim is make recommendations with the goal of enhancing patient recovery and wellbeing and reducing risks. Objectives are to: 1) understand the wellbeing, quality of life, and health recovery needs of older forensic patients in secure and community settings; 2) identify patient and professional perspectives regarding the barriers and facilitators to recovery, wellbeing, health and progress along the care pathway; 3) produce recommendations for best practice for working with this population; which can contribute to national standards, service development, and the design of interventions. To understand needs, and barriers and facilitators to progress, in-depth interviews with patients and staff working with them will be undertaken. Enabling the voice of both patients and staff. Using self-report measures this project will also gain patient wellbeing, health, cognitive functioning, and recovery levels. A project advisory group will include older adults with experience of mental illness and the criminal justice system to gain their perspective in project set-up, delivery, and reporting results; and are involved in designing project materials, interpreting qualitative data, and dissemination. Dissemination will be carried out through professional networks, social media, input into guidance and standards documentation, conference presentations, and academic, lay, and professional publications.