The Experience of Long-Stay in Secure Psychiatric Hospitals in the UK: The Patient Perspective
There are long-standing concerns that forensic patients may be staying in high and medium secure care for too long. However, ‘long-stay’ remains undefined, and research on the determinants of long-stay has been limited and undertaken mainly from an institutional or staff perspective. Research that has investigated the patient’s perspectives of secure care has focused upon quality of life and desired service provision. This study aimed to explore patients’ perceptions and experiences of prolonged stay in secure care. Semi-structured interviews were conducted with a purposive sample of 40 patients from 8 high and medium secure hospitals. Thematic analysis was carried out using a framework approach. A narrative analysis approach was used to explore the relationship between emergent themes at an individual case level. Several key issues were discussed by participants in the context of their current situation, their reasons for long-stay and their potential to move on from secure care. A typology of four long-stay stances was developed in relation to these themes: dynamic acceptance, dynamic resistance, static acceptance and static resistance. These stances illustrated differences in the extent to which participants believed that being in secure care was helping them to get better and whether they were actively trying to progress to leave secure care. Service providers should be mindful of these stances to provide patients with individualised opportunities to progress through the secure care treatment pathway.
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