Journeys into and through forensic mental health services

Accounts of their relative’s journey into and through forensic mental health services became the key focus of many of the interviews.  They clearly needed to share their narratives, and for some, they were doing this for the first time.  As one carer said ‘it’s absolutely amazing getting to chat to you and explain my side of the story.’

Escalation of mental health problems, involvement with the criminal justice system, and behaviour resulting in appraisal that the person posed a serious risk to themselves or other people, were the key triggers precipitating entry to forensic mental health services.  This might be admittance to high secure at the State Hospital or a move from an acute psychiatric ward to a low secure facility because of concerns over an individual’s safety.

Others were transferred to both high and low secure from prison, from general psychiatric care to low or community forensic mental health services, or combinations of moves between different levels of secure services.  For one person, involvement with forensic mental health services followed on from a psychiatric assessment at the end of a short prison sentence:

At the end of a six month sentence they sent for a psychiatrist who came and within 10 minutes told them she felt he had hyper mania.(partner) 

Parents and siblings identified troubles which, with hindsight, began in adolescence and with involvement of young people’s, mental health and, in some cases, criminal justice services.  One parent traced a journey that began when their relative was in her teens, resulting in admissions to a series of mental health and then forensic mental health services over a period of around 16 years.  Another stated:

Looking back, his teenage years were kind of a bit turbulent and I think we thought he was being a teenager but perhaps looking back there was more to it than that.  So he first became ill at university and he came home in the middle of second year, kind of crashed out and then he was more or less home for a year and a bit and that was a difficult time…(mother)

Some forensic carers found out ‘by accident’ that their relative had been placed in secure services.  Typically they reported feeling ‘traumatised’, ‘uninformed’, and ‘left out’.  As one stated, ‘we were told he was being transferred to Carstairs and that was it’.  Another, whose relative had become estranged said, ‘I didn’t know anything’ until informed by the police that her relative was in medium secure care.

While the knowledge that their relative had been placed in forensic mental health services invariably came as a ‘shock’, it brought relief to some carers who had been struggling to cope and were desperate for their relative to get some help – ‘it felt wonderful to know he was safe, it took a lot of pressure off’.

Individual journeys into forensic mental health services were varied but some experiences proved common.  For instance, the experience of raising concerns about the escalation of mental health problems, or of threatening behaviour, and not feeling listened to was commonplace.  Concerns had been raised with GPs, the police and with mental health services, but carers were left feeling unsupported and their views unheard:

I was phoning his doctor a lot of times. I phoned the police and the police used to say until he does something we can’t intervene’ and the doctor would say `if you’re worried about him phone the police’ and this went on and on and he got worse…’(mother) 

This applied equally when their relative was well known to mental health services, and even where mental health professionals were regularly involved through community compulsory treatment orders:

Leading up to the event, the incident, it was… it’s been a terrible traumatic time because we had all been involved as a family trying to help him and basically every time we were phoning for help it just seemed to fall on deaf ears, it was you know `oh well we’re dealing with it’ or `you know he’s known to the system’ but they just didn’t seem to take on our concerns at all, nobody seemed to you know appreciate the seriousness… (sister)