Personal recovery within forensic settings – Systematic review and meta‐synthesis of qualitative methods studies

Abstract

The themes identified provide for theoretically informed and testable developments in care that could enhance the quality of recovery and rehabilitation for offender patients through explicitly enhancing personal sense of safety, understanding the patient's sense of personal identity and their social networks and transitioning between institutional and community support.

Recovery and forensic care: Recent advances and future directions

“…These themes overlap and extend the findings of Shepherd et al (), who synthesised five of the same studies included in the Clarke et al () review. They identified three major themes as supporting the recovery process: hope and social networks, a personal sense of safety and security (provided by the physical environment, relationships with care providers, or both), and identity work (making sense of past experiences, understanding the role of disorder, and constructing a sense of self).…”

“…Several studies have now identified key principles of recovery as expressed by forensic mental health service users (e.g., Drennan & Aldred, ; Drennan & Woolridge, ; Livingston, ; Livingston, Nijdam‐Jones, Lapsley, Calderwood, & Brink, ; Nijdam‐Jones, Livingston, Verdun‐Jones, & Brink, ), including two reviews (Clarke, Lumbard, Sambrook, & Kerr, ; Shepherd, Doyle, Sanders, & Shaw, ). Clarke et al () conducted a systematic review and narrative synthesis of the 11 qualitative studies on offender‐patient perceptions of personal recovery, identifying six super‐ordinate themes: connectedness, sense of self, coming to terms with the past, freedom, hope, health, and intervention.…”

“…This fits well with the conservative optimism of forensic mental health practitioners who are concerned to work with the challenge of reconciling a sense of personal guilt or responsibility on the part of the offender‐patient with the impairments conferred by mental illness (Dorkins & Adshead, ; Drennan, Law, & Aldred, ; Moore & Drennan, ). The emerging themes of safety and security (Shepherd et al, ) are of importance considering that institutional obligations to maintain physical security have been cited as barriers to fully embedding recovery‐oriented principles in forensic settings. Drennan and Woolridge (), however, noted that security requirements such as restrictions of movement or compulsory treatment may, paradoxically, create an environment of safety and predictability in which the first steps towards recovery become possible.…”

To formulate or not to formulate? A case study

“…Livesley (2005) described five phases for helping people with personality disorders; Laura's current treatment fits into the second step (containment) for which the aims are to stabilize emotions, manage distress and provide structure whilst starting to build therapeutic relationships. Additionally, Shepherd et al (2016) explain that providing safety and security is important for future recovery. Ultimately it was hoped that Laura could begin to develop an understanding of her emotions and resulting behaviours and engage in low-stimulus activities to occupy her time and reduce boredom (Green & Robinson, 2005), which Laura has said can trigger agitation.…”

A protocol in action: Recovery approach for patients within high secure care: A 20+ year follow‐up

“…The need for research within this area has been previously highlighted . More recently, Clarke et al and Shepherd et al have answered this call by publishing meta synthesis of 11 and 5 qualitative studies, respectively, exploring the subjective recovery of forensic mental health patients. Recovery has been most commonly explored qualitatively using a cross‐sectional design.…”