Being a Forensic Carer
From the outset, applying the term ‘carer’ to family members and friends who support individuals in forensic mental health services in hospitals and the community was problematic. They did not always define themselves as carers, and health professionals in forensic mental health services did not necessarily view them in these terms, both of which had an impact on our ability to reach those who were the focus of this study. Even some of those who completed our survey of forensic carers or took part in interviews preferred to identify themselves as someone’s mother, father, sister, a supporter or a visitor rather than as a carer.
Some, on the other hand, did specifically identify with being a carer and some felt they had entered into the role of carer when their relative or friend entered forensic mental health services. Applying the label ‘carer’ to those going through this experience is therefore complex and highly contentious. Notwithstanding this, the study shows that the experience of being a forensic carer brings its own specific challenges: it is clearly a substantial role associated with significant responsibility (as described by our carer participants), a role that is, perhaps, insufficiently recognised in national strategies and by some professionals in their dealings with family members.
The findings from this study demonstrate that being a forensic carer is a complex and challenging role. Service level responses to carers therefore need to be equally sophisticated. A lack of understanding about carers’ needs was found by other studies (Canning et al, 2009) to be a barrier, but one of the benefits of providing support is that it facilitates better understanding of the needs of carers. Information exchange in particular can enhance carers’ satisfaction with services (MacInnes et al, 2013). This reaches beyond forensic mental health services to other agencies working with this group of carers, including police, advocacy services, and housing, as well as to general mental health and learning disability services who may be supporting these families prior to their use of forensic mental health services. There are also implications for official strategic responses to meeting carers’ needs which need to move beyond general reference to ‘substantial’ and ‘weekly’ care to embrace the specific emotional and practical challenges that forensic carers face.
The caring role presents numerous specific challenges that have to be surmounted. Staff in forensic mental health services need to appreciate that carers often need help and support when their relative moves between secure services, as well as on admission from prison or general psychiatric services. This research has shown that during such transitions carers do not always feel supported by forensic mental health services. Preparation and support prior to the first visit to any secure unit, for example, was identified by carers as essential. They also highlighted gaps in information about forensic mental health services, the MHCT Act, as well as about their rights as carers, even though services identified this as major part of their existing support to carers. While the majority of services reported providing information leaflets, the quality of these varied greatly. Others (e.g. Canning et al, 2009) have found that the usefulness of information packs is clearly dependent on their content. Overall, there was limited evidence of consistent good quality information and support being available from forensic mental health services in Scotland.
It was very clear that carers welcomed the opportunity this study represented to talk about their experiences. The stigma surrounding forensic mental health services can prevent carers from sharing their stories and worries with others, so that they feel isolated and perceive their experience as unusual. For some, there had not been institutional opportunities to speak and work through these experiences either in informal conversations or in a more therapeutic relationship