Inside out: research and forensic services

Mental Health Nursing,  May 2005  by Pollock, Laurence

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Involving forensic service users in social enquiry and research design has been seen as particularly difficult. Faulkner and Morris (2003) suggest that they might not be interested in research involvement. But one group of researchers and service users are plotting a different way forward. Laurence Pollock met some of them. All names of service users have been changed

Forensic mental health service users are among the most excluded in society. The double stigma of criminal justice system and mental distress often excludes this group from the sympathy of both professionals and the general public. A mentally ill man who has experienced prison, however vulnerable and neglected, is a Sun headline waiting to happen.

But City University researchers found the opposite. Within a forensic mental health secure unit, ten out of 12 service users willingly agreed to take part in in-depth interviews and discuss their experiences of living within a forensic secure unit.

Now a new project will extend the work carried out at by City University and the Revolving Doors Agency. Facilitated by research staff at City, 10 service user researchers are constructing the project's objectives and programme. They might, for example, research their past and present experiences of the criminal justice, health and social care systems. They could adopt qualitative methods such as focus groups, biographical accounts, interviews with people of significance to the service user researchers and recordings of their care programme approach meetings.

The research team will develop a service user-led dissemination strategy, which might include producing user-friendly information packs and educational materials for professionals. The project will also inform forensic mental health care research, and test procedures and good practice for user-led mental health care research.

Forensic mental health care service users, who are living in the community, were recruited through their contacts with organisations such as Revolving Doors Agency and Women in Special Hospitals (WISH), and from other services within the London area. The research project provides employment and offers service users the opportunity to acquire research skills and contribute to service development. The project aims to empower service users and enhance self-esteem and social inclusion.

Jacqueline Davies a research fellow at City and a project group member recalls her early experience of working in this area: 'I was in the local forensic unit and I was asking the wrong questions.

'I thought "wouldn't it be good if the people on the other side were involved in developing questions?'

'It was not in the interest of the service users to be honest with me. Every interview was like a rehearsal and they were worried that if they gave the wrong answer they might not be discharged.1

Paul Godin the principal investigator of the current project also identifies the imbalance of power in this kind of relationship: 'People inside are just waiting for something to happen. They are used to a whole sequence of people seeing them. The researcher is the most entertaining event in the ward that week.'

The frustration which all service users express about research concerns the absence of any apparent improvements arising out of it.

The forensic group which meets at City University experiences this particularly strongly.

Mark, for instance, says he gets very despondent that a piece of research will make any difference: 1I hope it does open people's eyes about how we are treated. We are all stereotyped. Institutions are run by fear and you have to toe the line or else. I was at Rampton for eight years and it was run like a military regime.'

Alan Simpson a leading researcher at City University sympathises. But the frustration is not limited to service users: There are a lot of people who work delivering services who also ask - what is the point? It won't make any difference.'

He believes it can make a difference but it is a slow process: 'In 1984, when I trained, there was nothing like this going on. There were no user led groups and service users were not involved in teaching.'

Whatever progress is being made on a broad front, members of the service user research group still feel that poor practice exists on the ground and they are not listened to. Eric, for instance, assaulted a member of his family. He said staff tried to alienate him from his family, forced him to speak English in their presence and denied him privacy.

Jack says of the project: I am very excited, I want to be heard about how bad it is. I was complaining a lot but I was not heard.'

He would like to see techniques in training which equip nurses to help someone to calm down. Such practices are well known but Jack can see no connection between past surveys and the conditions he experiences in forensic settings.

City University and The Revolving Door project are seeking to throw new light on those conditions and find ways of learning from those affected by them. But the 'professionals' have recognised that it is service users, even in extreme situations, who offer the best insights into how progress can be made.