Exploring the experience of community adjustment following discharge from a low secure forensic unit

Low secure forensic services have been identified as a common interface between inpatient care and care in the community. However, to date, no research has specifically explored the lived experience of discharge from such units. The present study aimed to address this by using Interpretative Phenomenological Analysis (IPA) to explore experience and sense making around community adjustment up to a year after discharge from two low secure forensic units in West Yorkshire. Theories of change, transition and identity, which were identified as potentially relevant to understanding the adjustment experience were incorporated into a semi-structured interview schedule, which was used to interview six people about their experiences. Three key findings emerged from the study. First, adjustment was characterised by both change and continuity. While to some extent participants were able to disengage from an inpatient role granted on the units, which was characterised by a loss of autonomy and identity, in other ways they remained changed by their experiences and struggled to move on towards a preferred identity or towards valued life goals following discharge. Secondly, ambivalence existed between participants seeing adjustment as a personal journey whilst simultaneously feeling internal and external pressure to strive for ‘normalcy.’ Finally, in addition to presenting an adjustment challenge, discharge for many represented the first opportunity to work towards recovery, heightening the magnitude of the discharge experience. These findings have been discussed in relation to pertinent theories of identity and change. On the basis of the findings, recommendations have been made, including maximising retention of autonomy and valued aspects of service users’ identities during inpatient care and ensuring service users are at the centre of discharge planning to facilitate the adjustment process. In the context of these findings, further directions for clinical practice are discussed.