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Characteristics, needs and individual experience of older forensic psychiatric patients

What we did:

The study aimed to build evidence around older forensic psychiatric patients by answering the following research questions:

  1. What are the characteristics of older forensic psychiatric patients?
  2. What are their individual needs in different areas of daily living? 
  3. What is their personal experience of ageing while in secure care?
  4. Are the current services meeting the unique needs of older patients?
  5. What can be done, if anything, to improve the current service provision? 

Why we did it: 

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.

What the benefits have been:

This study might have several implications for clinical practice. Older forensic psychiatric patients present with unique characteristics and needs, and 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 among older forensic psychiatric patients, staff do not receive any training and, or, awareness raising in dementia. The examples of good practice in caring for the needs of older patients are sparse and based on the initiatives of individual services, potentially requiring the development of dedicated national policy to ensure equal service provision across services.

Who we worked with:

We worked with three secure forensic psychiatric services within Nottinghamshire Health Care Foundation Trust.


Claudio Di Lorito,