Transition from secure care: PSU, stigma and identity
Research type
Research Study
Full title
Exploring the impact of stigma and identity on transitioning from secure to community care among people with forensic mental health needs and problematic substance use: A grounded theory study
IRAS ID
333922
Contact name
Maike Klein
Contact email
Sponsor organisation
Lancaster University
Duration of Study in the UK
1 years, 2 months, 17 days
Research summary
Summary of Research
Some individuals with mental health difficulties and risk concerns may spend time on inpatient secure units in the United Kingdom (UK). These individuals often present with a history of problematic substance use (PSU). Inpatient secure services aim to prepare those individuals for community discharge. Once discharged, individuals can encounter challenges related to identity, stigma and, often, the re-uptake of PSU, all of which affects their ability to transition back into the community and follow pathways towards recovery.
This study will explore service users’ perspectives on transitioning from secure care to the community. It aims to develop a conceptual framework for understanding best practice around recovery support, barriers and facilitators of recovery in the community, as well as the impact of PSU, identity and stigma. This understanding will be useful for clinical psychologists and other health professionals in developing future practice guidelines and therapeutic services. The study will involve individual interviews with people living in the community, who have previously been in secure care units in the UK and who have a history of PSU. The research will be guided by stakeholders and service users within Merseycare NHS services.
Summary of Results
Some individuals with mental health difficulties and risk concerns may spend time on inpatient secure units in the United Kingdom (UK). These individuals often have a history of problematic substance use (PSU). Inpatient secure services aim to prepare those individuals for community discharge. Once discharged, individuals can encounter challenges related to identity, stigma and, often, the re-uptake of substances, all of which affects their ability to transition back into the community and follow pathways towards recovery. Despite the aim of secure services ultimately being to discharge service users to the community, much of the academic literature focuses on inpatient experiences as opposed to transition to or maintained living in the community.
The current study explored service users’ perspectives on transitioning from secure care to the community. Ten people with experience of this transition as well as a history of problematic substance use were interviewed. Based on these interviews, a framework for understanding barriers and facilitators of recovery in the community was developed. The findings highlighted systemic and personal processes operating across three phases: hospital admission, transition period and maintaining living in the community. Whilst in hospital, key themes were environmental and psychological adjustment. During transition, gradual independence was important. In order to maintain community living, connectedness and security facilitates identity development and empowerment. Operating across the three phases were changes over time and disempowerment. The findings of this study may be used to inform future practice guidelines, policy and design and implementation of therapeutic services.
This research was carried out as part of a doctoral thesis and was sponsored by Lancaster University. The study received ethical approval from the Health Research Authority (HRA) and NHS Research Ethics Committee (REC).REC name
East of Scotland Research Ethics Service REC 1
REC reference
24/ES/0007
Date of REC Opinion
15 Feb 2024
REC opinion
Further Information Favourable Opinion