In considering the issue of carer support from the perspectives of services and carers, this study has attempted to explain identified discrepancies in service delivery.  Examples of good practice in the support of carers were noted throughout the study, and these included investment in information exchange, carer support or development workers, carers support groups and behavioural family therapy.  However, a significant finding was that carer support is inconsistent across Scotland and within some units, and secondly that the reasons for low uptake of available support are understood differently by staff and carers.  Staff identified carer choice as a main reason for this, whereas carers identified a number of access barriers.

From carers’ perspective, the most important change that can be made is for staff to perceive carers as important to engage with, with needs of their own, as effective allies in a triangle of care, and to relate to them consistently in a welcoming and respectful manner.  The increased emphasis in health and social care policy on the importance of supporting and involving carers needs to become widespread practice.

The fact that carers can attest to the benefits of such an approach suggests that this is achievable in forensic mental health settings without compromising confidentiality or risk management.  While there is good practice, the most pressing issue would seem to be the need to further increase the range and spread of support, and to address the current inconsistent and patchy provision of carer support.

This study has a number of limitations including that it adds little to the literature on the separation of forensic patients from their children (Chao and Kuti, 2009), or the experience of diverse forensic carers, especially those from BME groups.  It has not specifically explored issues that may be specific to women who require forensic care or the needs of disabled people, but arguably these remain important areas for further research and practice development.

The notion of staff being ‘carer aware’ needs to extend to all staff working in forensic mental health services, and to include attention to the crucial importance of forging warm, respectful and constructive relationships with carers at all levels of the organisation.

If this can be consistently achieved, services would be better placed to improve first impressions, iron out perceived discrepancies between different parts of the service, particularly ward-based care, and to maximise the positive contribution that carers can bring to improving patient care and safety