What does social distancing mean for patients in forensic mental health settings?

Abstract

Abstract Governments across the globe have called for social distancing measures in response to the COVID-19 pandemic. These calls typically request non-essential workers to remain at home, stepping outside only for exercise or to purchase necessary groceries. Secure settings will not be able to comply with these strictly, nor will they have the same recourse to the novel and creative solutions the general population does. Activities have been restricted in quality, quantity and scope; transfers and discharges have been halted and patient progress put on pause. Understanding how and what ways these restrictions will affect patients is crucial. This is especially salient given that large numbers of the general population have reported heightened mental health burden in recent surveys. However, it is not yet clear how and in what ways the COVID-19 restrictions will affect the mental health of patients in secure care. Past research investigating patients experiences of restrictions on autonomy in secure care that were present before the pandemic can be helpful here. Studies suggest that patient experience restrictions in care in myriad subjective ways. These include limitations on family contact, outside leave, and making hot drinks but also more profoundly on their autonomy, sense of self, and personhood. Quantitative studies have found correlations between experiences of restrictiveness and ward atmosphere, quality of life, suicidal ideation, depression and general psychological state in this patient group. This paper suggests how we can use past research exploring patient expereinces of restrictive interventions to guide the implementation of social distancing measures in light of the COVID-19 pandemic.