“I’ll be better you know…I’ll get better one day.” Social climate, recovery, and risk in forensic intellectual disability: a portfolio thesis

Abstract

AIMS: Social climate, recovery, and risk are overlapping concepts that have received relatively little attention in relation to forensic intellectual disability (FID) populations. This thesis therefore sought to explore these concepts through the lived experience of patients based in FID services.

METHODS: The first study is a qualitative systematic review of social climate in FID inpatient wards. The review included sixteen studies exploring the experiences of staff and patients in FID secure services. Best fit framework synthesis was used to build upon an existing framework of social climate. The second study is a qualitative empirical study that explored the concepts of recovery and risk in FID. Eight patients based in a high secure FID service took part in the study. The lived experiences of patients were analysed using Interpretative Phenomenological Analysis.

RESULTS: The systematic review highlighted areas of overlap and divergence between the experienced social climate in forensic mental health and FID settings. The social climate framework was updated and refined to reflect the review findings. These included the influence of factors such as communication and the prior experiences of patients on the experienced social climate in FID services. These findings align with the increasing implementation of trauma-informed practice in forensic services. In the empirical project, analysis of patient narratives led to the development of three group experiential themes: “Searching for a sense of self”, “Stuck in the system”, and “Seeking connection”. The findings of this study highlight the relevance of identity, agency, and connections for patient participants.

CONCLUSIONS: This thesis suggests the concepts of social climate, recovery, and risk are uniquely experienced by patients and staff in FID settings, and there is need for this to be acknowledged and further explored in both research and clinical practice.