The experience of having a son conditionally discharged under Section 37/41 Mental Health Act 1983 and then recalled to hospital: An interpretative phenomenological analysis

Abstract

This study explores the lived experience of parents of male patients who have been detained under a hospital order with restrictions (section 37/41 Mental Health Act 1983), subsequently conditionally discharged into the community, and then recalled under the restriction order back to hospital. While much research has focused on the impact of having a relative with a diagnosis of mental illness, there has been a dearth of research into the impact of having a relative detained in a medium secure forensic unit. As yet, no research has been conducted into the experience of families where their relative has been discharged from a medium secure forensic unit, returning to the community after a long period of detention. Neither has there been any exploration into what parents experience if their son is subsequently recalled under the restriction order back to hospital. Interpretative phenomenological analysis was used as a way of exploring this experience for six parents of five sons who had been conditionally discharged and subsequently recalled to medium secure forensic psychiatry units in the South-East. The analysis yielded themes which related to the personal and emotional impact that parents experienced in terms of a cyclical pattern of hope when their son was discharged, followed by loss and fear, accompanied by a sense of powerlessness when his mental state deteriorated, and relief together with disappointment at recall. There was a reappraisal of the expectations they had of their son which enabled them to regain hope for him. A further theme of ii responsibility highlighted the responsibility that parents assumed for their son, doing what they can for him whether he was in hospital or the community. Although they desired him to progress and be autonomous, parents recognised that their son may never be fully independent and may always require their support. They hoped that when he was conditionally discharged they would be able to share this responsibility with the supervising team. However, it seemed that when their son‟s mental state deteriorated, parents struggled to enlist the help of mental health services and were uncertain as to who held responsibility for him. Feeling isolated and unsupported at this time, they also felt blamed by services, reciprocating by blaming services. Not only unable to get what they perceived as an appropriate level of help for their son from services while he was conditionally discharged, parents described trying to access a system that seemed impenetrable, and responding only when „something had happened‟. When he was finally recalled, they experienced the system as having engulfed their son, and recognised how difficult it would be to get him out. Throughout the whole process they felt that their own expertise as parents was marginalised, and they described not feeling part of the team despite Governmental stress on carers being recognised as expert partners in care by services. A number of limitations of the study are discussed, together with the researcher‟s reflexive account and implications for practice. The study offers a deeper understanding of what parents in this situation may experience, and offers a broader perspective for those who work with them.