Service user perspectives of preparation for living in the community following discharge from a secure mental health unit

  • Deborah Alred

Student thesis: Doctoral Thesis


Recovery orientated practice is an expectation of current service provision in forensic mental
health services. It has been suggested that there are specialist recovery needs of people
with mental illness and an offending history; however these have not been explored in
research to date. This study aimed to address this gap in knowledge by examining the
opportunities and challenges encountered by service users returning to the community
following discharge from a forensic mental health unit. It aimed to carry out the study in a
way that incorporated the recovery principles of service user involvement, so the specific
study question was identified in a service user consultation.
Six service users who had been discharged from a forensic mental health unit and were
living in the community were interviewed. They were asked about their preparation for
discharge and their experiences of living in the community. Specific recovery tasks for
forensic service users were identified, which are either the result of having a history of
offending or another aspect of the secure pathway such as length of stay. The research team
called these the “Getting Out and Staying Out (GOSO) recovery challenges”. Some of the
GOSO challenges have been identified in previous research but the study also identified
some novel issues facing service users. This is the first time the recovery tasks have been
collated for this group. The findings provide a more comprehensive understanding of
recovery for service users with a forensic history.
The GOSO challenges have an application for clinical practice and policy. They provide a
structure from which a group intervention or recovery college course can be developed. They
offer a framework to support individuals and clinicians to identify recovery goals, taking into
account the impact of the offence. They provide a more detailed understanding of the impact
of having offended on mental health recovery. They can therefore be used to inform policy
and national guidelines. Attitudes to risk management are also challenged as risk reduction
through engagement in meaningful activity is highlighted.
The study utilised a participatory methodology grounded in Habermasian critical theory. Two
service user researchers (SURs) were employed and trained in research skills. They
supported the development of the study protocol including the ethics approval process; they carried out the interviews and contributed to the data analysis. A three-stage data analysis
process was employed utilising a collaborative narrative approach to transcript analysis as
well as framework analysis. It was designed to support a shared data analysis process.
Critical or emancipatory research has a dual aim to seek out knowledge and support the
flourishing of individuals. Involvement in the study increased the SUR’s confidence and
developed their critical and reflective skills. This has resulted in both SURs achieving
employment in peer roles and additional research projects.
Participatory research methodology is relatively uncommon in occupational therapy research.
The study therefore ends by proposing a model for supporting communicative action within a
clinical research setting in order to encourage future participatory studies.
Date of AwardFeb 2018
Original languageEnglish
Awarding Institution
  • University of Brighton
SupervisorKay Aranda (Supervisor)

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