Experiences of family caregivers in forensic mental health care-A qualitative evidence synthesis

Experiences of families when a member is in forensic psychiatric care: a phenomenologically based thematic interview study

Introduction

This article focuses on the meaning of being a family when a member of the family is cared for in forensic psychiatric care. The latter operates at the crossroads of psychiatric services and the legal system, making it a highly complex area of care. Families play a vital role in supporting recovery from mental illness, however, when a family member has committed a crime and suffers from severe mental illness, pressure and stress of a complex nature are felt by the family. The aim of this study was to describe the lived experiences of families when a member is in forensic psychiatric care.

Material and methods

Seven family interviews (15 participants) were conducted and analyzed with a Reflective lifeworld approach in this phenomenological study.

Results

The findings reveal four themes; Being constantly affected by uncertainty; A struggle to maintain family relations - overcoming barriers in the form of restrictions; Trying to help despite inherent powerlessness and It is not just the patient who needs to heal when the family is wounded.

Conclusion

A family with a family member who is being cared for in forensic psychiatric care have support needs that are not fulfilled, even though these have been highlighted from several different perspectives. Healthcare professionals might be able to provide substantial support to the family by using simple yet effective methods, such as active listening and empathetic communication. By fostering an open dialogue and understanding, caregivers can help bridge gaps and facilitate better outcomes. A family-oriented practice should thus become a fundamental component of caregiving strategies in forensic psychiatric care.

"It just felt like a rubber stamp": Family experiences of mental health review board hearings in Ontario, Canada

Involving families in the planning and delivery of care to relatives living with a mental health disorder is beneficial to achieve optimal recovery and medication adherence, and to reduce decompensation and hospital readmission rates. However, in the specific context of forensic mental health, the involvement of families in the planning and dispensation of care to relatives has been difficult. The purpose of our study, which was conducted in Ontario, Canada, was to better understand the interactions between families and the forensic mental health system. To meet this objective, we used a qualitative methodology, namely interpretive phenomenology. We collected data from 17 family members of persons in the forensic mental health system through semi-structured interviews. Interviews were analysed using a three-pronged approach with a particular attention paid to the spatial, temporal, and interpersonal dimensions of families' lived experiences. In this article, we present our findings related to families' experiences with the Review Board, a mental health tribunal responsible for the legal management of patients in the forensic mental health system. We regrouped the experiences of family members in four overarching, and occasionally overlapping, categories: (1) Preparation for Review Board hearings; (2) Review Board hearing processes; (3) Information Discussed during Review Board hearings; and (4) Format of Review Board hearings. Among other things, our findings highlight that Review Boards are experienced by families as rubber-stamping exercises, and that Review Board panels lack sociodemographic diversity. These findings have implications for healthcare professionals and mental health tribunals in Canada and abroad.

Has Family Engagement Finally Gained Foothold in Forensic Mental Healthcare?

Despite advancements in promoting family engagement in mental health settings, limited involvement of family members persists in forensic mental healthcare. Forensic mental healthcare professionals face various barriers in engaging families, including a patient-centered approach and resource constraints. However, limited understanding exists of professionals' experiences with family engagement, which is crucial for improving care practices in this setting. Consequently, this study investigates the evolution of professionals' experiences with family engagement from 2015 to 2021 in Flanders, Belgium. Qualitative methods were employed, including focus group interviews in 2015 and individual interviews in 2021 with 23 forensic mental healthcare professionals. Thematic analysis is employed to identify patterns and changes over time. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was utilised to report the study. The analysis revealed that while initial steps towards family engagement in forensic mental healthcare have been taken, full integration in organisational structures is still lacking. Future efforts should focus on involving family organisations and caregivers, addressing barriers like time and resource constraints, and fostering a cultural shift towards family engagement. Further research involving a broader range of stakeholders is needed to enhance family engagement initiatives in forensic mental healthcare settings.

Tilting at Windmills - A Qualitative Study about Family Caregiver Interactions and Perceptions in Forensic Mental Health Care

In forensic mental health care (FMHC), family caregivers perceive themselves as burdened in their relationships with the service user (the family member with mental illness) and by difficult collaboration with healthcare professionals (HCPs). There is a political objective to involve this group in the care and treatment of the service user in mental health care. To improve family caregiver involvement in care and treatment in FMHC, research about their perceptions is needed. This study aims to explore family caregivers' perceptions of their interactions with the service user and HCPs. The method used was qualitative. Semi-structured, in-depth interviews with 12 family caregiver participants were carried out and analyzed thematically. The analysis resulted in three interrelated main themes: Strategies to normalize everyday living; Distrust of the quality of care; and Loss and grief. Family caregiver feelings of loss and grief may be suppressed, which additionally could prevent them from supporting the service user.

Walking Alongside: Views of Family Members on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition

Medical assistance in dying (MAiD) was introduced into Canadian federal legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is currently excluded from eligibility; such exclusion is scheduled to expire on March 17, 2024. Irremediability, capacity, quality of life, autonomy, family involvement, and healthcare system constraints have been debated intensively. Recent studies have not explored the views of family members of persons with mental illness on MAiD MI-SUMC. This study aimed to fill this knowledge gap. Twenty-five Ontario residents who had a loved one with mental illness participated. A persona-scenario exercise was designed to explore participants' views on MAiD MI-SUMC in hypothetical situations. Reflexive thematic analysis was used to analyze the data. A lived experience-advisory panel was engaged throughout the study. Seven themes were developed: Witnessing suffering; A road with barriers and limitations; Societal barriers; The unknowns of mental illness; Individual choices: the life or death that a person wants; MAiD MI-SUMC as an acceptable choice when suffering cannot be relieved with available treatments and supports; and The emotional outcome. Participants constructed their views based on their experience of supporting a loved one with mental illness. MAiD MI-SUMC was perceived as a multifaceted issue, whose acceptability and potential introduction required a concurrent exploration and discussion of the challenges arising due to limitations of the healthcare system, the opportunities and limits to family involvement, and the value of patient autonomy.