Growing older in secure mental health care: the user experience

Background: The proportion of older adults using secure forensic psychiatric services is rising. Research is needed to examine the experience of older service users and evidence how adult services can adapt to meet their needs.

Aim: To explore user experiences of being an older adult in secure forensic services.

Methods: Thematic analysis of interviews and observations of weekly routines conducted with fifteen service users aged 50 and over residing in a low and medium secure NHS unit in England.

Results: User experiences of ageing and age-related needs are reported using five themes: age-related identities; ward environments; participation in activities; management of physical health; and ageing futures. Older adults living with people their own age reported more social integration than those on wards dominated by younger adults. Most wished to self-manage their physical health needs with the support of primary care staff. Older adults were reluctant to identify as “old” or “vulnerable”. Some older adults downplayed their changing care needs.

Conclusions: Placement of older people in adult secure services requires awareness of the age balance of the ward. A culture of inclusivity, sensitivity and respect for older persons’ agency is key to collaboratively meeting additional care needs and discharge planning.