Views on quality

Views on the quality of forensic mental health services

Forensic carers’ perspectives on the nature and quality of forensic mental health care and treatment were variable.  While secure environments were generally ‘daunting’, their descriptions of forensic mental health services highlighted positive features of these settings, including consistent and caring staff.  Conversely, some were critical of what they perceived as inconsistent treatment that had a detrimental impact on their relatives:

He’s had lots of changes of treatment, so that’s not been good.  He’s had five consultants in a year or so because they’ve all been on three month contracts…(mother)

A medium secure unit was felt by carers to be ‘very modern in its approach’ on account of its staff being ‘empathetic and compassionate, just amazing’.  A forensic rehabilitation ward was described as a ‘good setup’, supporting patients to prepare for moving into independent living situations.  Support from a CPN in a forensic community team was described as ‘absolutely terrific’ in supporting an individual with his community treatment.  Comments about positive relationships with staff occurred across all levels of secure services, although specific criticism was reserved for what some felt were more restrictive regimes in the high secure setting:

They’re locked up and… in my experience treatment is minimal other than drugs. They’re extremely short staffed so you know they spend days sitting. It’s no different from the psychiatric institutions of the Edwardians as far as I can see except for better security (mother)

However, it was the understanding of another carer whose relative had been in high secure for two years that he was ‘in the best place, he’s getting the correct treatment’.  Some of the more negative experiences, especially of high secure, were located as historic rather than current experiences, and it was noted that there had been tangible improvements in recent years.  In particular, the more comprehensive range of forensic mental health services across Scotland meant the appropriateness of care and treatment had improved dramatically, and the modernisation of the built environment at the State Hospital was commented upon favourably:

A lot of my experience is more sort of historical than contemporary because my experience when I first went to the State Hospital were of being treated like a number, no support, no explanations and that wouldn’t be the case if you were going there today… A lot of my experiences have changed and the nature of the State Hospital’s changed now, I mean in those days there were 300 and something patents, now it’s 100 and something… it’s a high secure State Hospital, whereas before it was having to take people who really should have been in medium secure or low secure but there weren’t the facilities for them (father)

Nonetheless, some felt there was still some way to go before forensic mental health services, especially high secure care, catered for the individual needs of their relatives.  This was especially the case where patients had learning disabilities and/or autistic spectrum condition (ASC).  Positive change happened when their relative moved into ward regimes with staff operating ‘less like security staff or prison guards’.  A move to smaller wards at the State Hospital was also positively regarded.  In relation to this, one carer commented, ‘it’s opened up the place’, and ‘it does work better’.

Carers were critical of ‘punishingly high doses of medication’ and drug treatments that seemed to do nothing other than sedate and control patients.  Positive changes were noted when drug treatments were changed to suit the individual, so much so that one carer likened the difference when a new medication was tried to ‘turning on the light’.  In this case, the dramatic change in the person led clinicians to review the relevance of the prevailing level of security, and to consider a move to a medium secure facility.  Moving from ‘a level of intimidation’ to openly being able to discuss clearly defined targets and aspirations for their relative, was how one interviewee contrasted past experience of high secure services at the State Hospital with a more recent experience of medium secure:

You didn’t feel ‘oh if we say this or say that you’ll be here for another two years’ or whatever.  It was just a much more positive experience at the [name of medium secure unit] and you felt much more positive about the whole place (father)

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