Information flow, communication and quality issues
Receipt of such information was appreciated but some forensic carers emphasised the necessity of certain information needs by remarking on how they were not being met. Written information was not always appreciated as helpful, sometimes being regarded as ‘largely inadequate or misdirected’ (survey respondent). People’s experience of having their information needs met were variable, with a mixture of positive and negative experiences reported around access to information.
The quality of information received was rated as either good or very good by just over 61% of carers responding to the survey. Conversely, around a fifth said it was either poor or very poor. There are some mixed experiences. At one extreme, some carers reported receiving little or no information, or had had to seek out information rather than it being offered as a matter of course; some said they had gathered knowledge over time using their own initiative, for example, doing their own ‘research’ on the internet. Others were very appreciative of staff approaches to information and felt themselves to be involved in a two-way exchange process.
In contrast, a feeling of not being supported flowed from experiences of poor communication of key information:
I was not even told what the visiting hours were. I have never, at any point, felt supported – I do not even know what the plans are for my son (or even if there is a plan). It feels as though he will never get out of that place. (survey respondent)
There were differences between different members or disciplines of staff, or between different units in their responsiveness to requests for information or whether or not their approach to informing relatives was proactive. Several of those interviewed noted how services had improved over time, including that approaches to information giving were better now than they had been on first contact with forensic mental health services. Some contrasted this favourably with far more negative experiences with mainstream mental health services and personnel, especially in a prior context of not feeling listened to or having their views respected.
On the one hand, some carers felt that forensic mental health services were somewhat closed and insular:
I think the downside of forensic health services for me, I just wish they would be a wee bit more open. (wife)
Alternately, forensic carers we interviewed appreciated receiving information from staff in an effective and timely fashion, or the fact that staff made time for information giving, and this formed the basis of good relationships with them:
So it wouldnae matter whether it was myself, my mother or my sister that phoned, they’re very very good at giving you the information that you’re requesting. (sister)
Receiving valued information can be empowering for carers, but some carers also pointed out the limits:
I mean it doesn’t wave a magic wand and change anything, you know. You could be super intelligent about all these facilities, but you… cannae get him tae stop ranting and raving when he’s on a high. (mother)
To some extent, a distinction was made between feeling listened to and actually being able to really make a difference to care, some of which was acknowledged to be constrained by guidelines and protocols. In the survey, around a quarter of carers reported feeling they could influence services, whilst over half felt they could not, with the rest being unsure.
The case for better quality information was emphasised in the range of understandings described by carers, which included a spectrum of beliefs about care from punitive to humane models. Others had become very understanding both of mental health issues and the complexities of providing care in secure units in the course of receiving information and support over the years. For some, information about mental health problems or symptoms was pitched at too superficial a level. They sought information to help them to develop a deeper understanding of their relative’s individual behaviour and experience.