Exploring health care professionals’ experiences of supporting LGBTQ+ patients: a qualitative study

BACKGROUND: Patients from the LGBTQ+ community report negative healthcare experiences, such as healthcare professionals (HCPs) making assumptions about their identities. Research shows that HCPs report not having enough knowledge to facilitate an open conversation with patients from the LGBTQ+ community, leading to patients feeling ignored. AIMS: To explore HCPs’ experiences of supporting patients from the LGBTQ+ community. METHOD: Semi-structured interviews were conducted with HCPs recruited from the research teams’ professional network. Data were analysed using deductive thematic analysis. FINDINGS: HCPs reported positive and negative experiences, as well as a variety of barriers and facilitators to effective communication, with patients from the LGBTQ+ community. HCPs discussed how clinical practice could improve, for example, by developing more inclusive training that is specific to the HCPs’ clinical group. CONCLUSIONS: HCP training needs to be more inclusive of LGBTQ+ identities. It should be tailored to the HCPs’ patient group as this better reflects the varied needs of different clinical groups. Chelsea Pearce and Claudio di Lorito explore health care professionals’ experiences of supporting LGBTQ+ patient

Exploring the individual experiences of LGBT+ patients with general practice staff: an interview-based study

In this qualitative study, Sophie Whyman and Claudio Di Lorito explore the experiences of LGBT+ patients in general practice. / Background: General practitioners (GPs) are usually the first port of call for health-related issues. The attitudes and behaviours of staff working in general practice can influence patient outcomes and access to services. / Aims: This study aimed to explore the experiences of LGBT+ patients with staff working in general practice. / Methods: Qualitative interviews were conducted with LGBT+ participants recruited through the York LGBT Forum and social media and analysed using thematic analysis. / Findings: Six participants were included. The participants reported mixed experiences, which had a great impact on their disclosure, treatment outcomes and future service access. Recommended improvements included standardised training and administrative changes. / Conclusion: There is a need for standardised NHS-wide inclusiveness training to support staff in general practice to better understand non-heteronormative experiences in their clinical practice

The characteristics, needs and individual experience of older forensic psychiatric patients: across-sectional study in three secure units within one regional service

Intro. Secure forensic psychiatric settings in the United Kingdom offer treatment to mentally-disordered offenders or non-offending patients who present a risk to themselves and others, given the severity or nature of their symptoms. In the last decade, several demographic, socio-cultural and legal factors have caused an increase in the prevalence of patients over 50 years, who currently represent around 20% of residents in forensic psychiatric settings in the UK. However, population growth has not been matched by research. With little to no evidence, it is therefore difficult to determine whether secure services are adequately addressing the individual needs of older patients. Aims and objectives. The present study aimed to build evidence around older forensic psychiatric inpatients in three public (i.e. NHS-funded) secure forensic psychiatric services in Nottinghamshire, by answering the following research questions: (i). What are the characteristics of older forensic psychiatric patients? (ii). What are their individual needs in different areas of daily living? (iii). What is their personal experience of ageing whilst in secure care? (iv). Are the current services meeting the unique needs of older patients? (v). What can be done, if anything, to improve the current service provision? Methods. The project comprised several phases. The preliminary groundwork, which informed the study protocol, consisted of systematic reviews around older people in restrictive settings (Chapters 2, 4 and 5) and in an international case-study to investigate alternative service provision (Chapter 6). The empirical phase of the project consisted of: 1. Investigating the sociodemographic data of all older patients living in three public (i.e. NHS-funded) secure units (Rampton Hospital, Arnold Lodge and the Wells Road Centre) within Nottinghamshire Healthcare NHS Foundation Trust (Chapter 7) 2. Investigating data on socio-demographics, residency, admission, offences, mental health, treatment, physical health, risk and incidents of a sub-sample of patients within these units, by looking at their clinical notes (Chapter 7) 3. Assessing their individual needs in different areas of daily living through administration of the CANFOR-S (Thomas et al., 2003) (Chapter 7) 4. Assessing their cognitive abilities through administration of the CAMCOG-R (Roth et al., 1986) (Chapter 7) 5. Collecting enriched narratives on their experience of ageing whilst in secure care through administration of qualitative interviews (Chapter 8) 6. Investigating the views of members of staff around service provision in meeting the needs of older patients through focus groups (Chapter 9) Results. The preliminary groundwork highlighted a lack of updated information around older patients in forensic psychiatric settings, thus indicating a need for research in this area. Of a total of 496 patients in the three services, 94 (18.9%) [95% C. I. (15-22)] were aged 50 or over. Forty-one older patients (a response rate of 44%) [95% C. I. (34-53)] gave consent and were assessed in studies 2, 3 and 4. The participants presented with complex physical and mental health needs. Long-stay was prevalent and significantly associated with older age, showing the patients’ challenges to move along the care pathway. Participants’ needs were mostly met, but negative feedback was gathered around social opportunities. Cognitive impairment affected 25% [95% CI (15-41)] of the sample. Fifteen patients were sub-sampled for study 5. Despite the positive feedback reported around physical health care, education opportunities, staff and support of religious practices, participants experienced barriers to recovery, caused by social isolation/withdrawal and activities/treatment that did not respond to their complex age-related needs, generating poor motivation to engage. For study 6, three focus groups were carried out with 13 members of staff from two of the three research sites. The participants reported unique age-related issues, which may impact on the patients’ opportunities for recovery, including a lack of specialist training for members of staff, prolonged stay in secure care and a limited number of age-relevant activities. Conclusion. The older participants presented with unique characteristics and needs. Currently, a number of factors keep them motivated and engaged in the treatment process, thus favouring recovery. These include adequate provision of physical healthcare, a variety of age-appropriate educational activities and extensive support from members of staff. However, older patients still experience a number of barriers to recovery, including prolonged stay / long-term institutionalisation, release anxiety, few age-relevant occupational and recreational activities / treatment, limited social opportunities and neglect of sexual needs. Despite the high prevalence of cognitive impairment found in the sample, staff did not receive any training / awareness raising in dementia. The examples of good practice in caring for the needs of older patients were sparse and based on the initiatives of individual services, potentially requiring the development of dedicated policy to ensure equal service provision across services. Further research with more representative (i.e. national, in the private sector) samples is needed for accurate service evaluation

Ageing in forensic psychiatric secure settings: the views of members of staff

Background: Although the prevalence of older patients in forensic psychiatric services is increasing, research around service provision for this population is very limited. We aimed to gather the views of members of staff on how well secure services are meeting the challenges of an ageing population.Methods: Three focus groups were carried out with 13 members of staff working with older patients in secure services. A topic guide, based on the research team’s previous research, guided the sessions. The focus groups were audio-recorded, transcribed and analysed through thematic analysis.Results: Two themes were identified: (1) Identifying patients’ needs, which focused on how promptly any emerging issues in the older patients are identified and reported; (2) addressing patients’ needs, which focused on how the unique needs of the older patients are addressed, once established.Conclusions: There are unique age-related issues that may have an impact on the older patients’ opportunities for recovery, including a lack of specialist training for members of staff, prolonged stay in secure care and a limited number of age-relevant activities. Far from optimal, provision requires improvement through the active involvement of the primary stakeholders

Long-stay and ageing

Older forensic psychiatric patients stay in secure services longer than prisoners sentenced for the same offence, patients in general psychiatric settings and forensic psychiatric patients of all ages. Prolonged stay may reflect that service provision is far from meeting the unique needs of this population, but research in this area is very limited. Drawing from the existing literature in forensic psychiatry and in other restrictive settings, this chapter aims to: (i) present data on older patients in relation to their prevalence in forensic psychiatric settings, sociodemographic characteristics, violence, mental health and individual needs; (ii) present data on length of stay in comparison with other populations in secure care; (iii) report and discuss issues around the long-term care of older patients, including physical health care, the presence of cognitive impairment and dementia, (the potential development of) national long-term units for patients with intensive care needs and the need for age-relevant treatment and activities. Potential implications for service improvement in relation to policy making and research are also discussed

Ageing in forensic psychiatric secure settings: the voice of older patients

Older patients account for around 20% of the population in secure forensic psychiatric services in the UK. However, little qualitative research has investigated the experience of ageing in secure settings. This study aimed to gather the individual views of a sample of patients over 50 years old in the UK at different levels of security. Fifteen participants were selected and underwent one-on-one qualitative interviews. The interviews were analysed through thematic analysis, which generated seven themes: Self-agency, activities, social life, practical matters, recovery, physical health and service improvement. Study findings highlighted the complexity of ageing in secure settings. Despite the positive feedback reported in aspects such as physical health care, education opportunities, staff and support of religious practices, participants experienced added barriers to recovery, caused by social isolation/withdrawal and activities/treatment that did not respond to their complex age-related needs, generating poor motivation to engage. Our findings call for the development/implementation of programmes tailored to the unique needs of older patients. This process requires an active involvement of the primary stakeholders and further patient-centred research

The characteristics and needs of older forensic psychiatric patients: a cross-sectional study in secure units within one UK regional service

Although the number of older patients in forensic psychiatric settings is increasing, there is limited information around their sociodemographic characteristics, needs and cognitive abilities. This cross-sectional study focuses on patients aged ≥50 years in three (high, medium and low) secure forensic psychiatric services in England. The study comprises: 1. Analysis of sociodemographic characteristics of all patients (n = 94) in the services; 2. Analysis of the clinical notes and administration of needs and cognitive assessments to a subsample of patients (n = 41). The main outcomes include: sociodemographic characteristics, data on residency, risk, violence, mental and physical health, cognitive ability and individual needs. Data analysis is carried out through descriptive tests and correlation and inferential analyses of outcomes. Results evidence that most patients are White-British single males aged 50–54 years and 88% have at least one physical health condition. A quarter of the patients has cognitive impairment. The most common psychiatric disorder is Personality Disorder (60%); comorbid psychiatric disorders are prevalent (54%). Length of stay averages 6+ years and is longest in high security. Patients’ needs are mostly met. The least met needs are social opportunities. Future comparative research against younger populations could give better context to research findings from this study

Older people as victims and perpetrators of crime

Older people are at a higher risk of becoming the victims of crime than of being the perpetrators of it, given the added vulnerability that comes with aging. This chapter examines crime in relation to old age. The first section presents data around older people as victims of crime, and further discusses different types of abuse against older people, which, in the presence of intensive care needs and carer burden, may be perpetrated within the family or in residential and institutional settings. The second section of the chapter examines older people as the perpetrators of crime. In particular, it describes how older offenders are dealt within the justice system, it presents data on the growing population of older offenders in prisons and in forensic psychiatric services and report on whether the unique needs of older offenders are being met in these settings

Ageing in forensic psychiatric secure settings: the voice of older patients

Older patients account for around 20% of the population in secure forensic psychiatric services in the UK. However, little qualitative research has investigated the experience of ageing in secure settings. This study aimed to gather the individual views of a sample of patients over 50 years old in the UK at different levels of security. Fifteen participants were selected and underwent one-on-one qualitative interviews. The interviews were analysed through thematic analysis, which generated seven themes: Self-agency, activities, social life, practical matters, recovery, physical health and service improvement. Study findings highlighted the complexity of ageing in secure settings. Despite the positive feedback reported in aspects such as physical health care, education opportunities, staff and support of religious practices, participants experienced added barriers to recovery, caused by social isolation/withdrawal and activities/treatment that did not respond to their complex age-related needs, generating poor motivation to engage. Our findings call for the development/implementation of programmes tailored to the unique needs of older patients. This process requires an active involvement of the primary stakeholders and further patient-centred research