Experience of change in services
Survey respondents supported individuals who had a variety of histories in and through forensic mental health services: 38% had experienced a move from prison to forensic mental health services and 43% had experienced moves between mental health services including between secure settings. Interviewees spoke at length about transfers from hospital or prison to forensic mental health services or between levels of secure services. Moving to forensic mental health services from general adult psychiatry had, for some, resulted in improved care and treatment, and better consultation with carers:
Nobody [in general psychiatric hospital] had thought to pick up the phone and check… the assumption was we were going to be there. With [name of secure unit] that doesn’t happen, they’re very careful, very careful and considerate and they know that we’re doing the support so you know they check and they’re also interested to know how visits have gone (mother)
Moving from hospital to the community could be experienced as extra pressure on carers as they anticipated that the burden of caring would fall to them. Supporting individuals under community forensic mental health services is an area fraught with difficulties, and carers will have differing needs to those supporting relatives in hospital. Survey respondents, as well as those we interviewed, who were supporting a relative in the community, were sometimes confused about whether the person was under community forensic or general community mental health services. Those with relatives who had moved through secure levels and into community forensic mental health services chose to focus on their experiences of higher levels of secure services. Changing between services meant carers having to forge relationships and communicate with new staff teams at every stage, which sometimes brought additional stress for them, although it might be beneficial:
Sometimes you can look at that as a positive because people have different and new ideas and different approaches and there might be new people coming in that can have a fresh pair of eyes. (mother)
There were extra responsibilities for carers at times of transition between services as this parent explains:
We’ve had to support our son in jumping through hoops and meeting criteria in order to move from one stage to the next and always with it in the back of our mind that if we question things his stay in one level of security would become prolonged (father)
Interviews with forensic carers indicated that the experience of carers was not static. Carers are affected by changes in the health and the treatment of their relative and its impacts on them, as well as by organisational and personnel changes that impact on their communications with their relative and with professionals. Overall, there were indications of some improvements for forensic carers over time, as well as some disruptive and negative consequences.