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Forensic psychiatric services work with people with mental illness and who pose a risk to themselves or others deemed to be sufficiently high to require confinement to secure facilities, or risk assessment and management in the community (JCPMH, 2013). Older forensic psychiatric patients (defined as aged 55 or over) typically have histories of childhood neglect/abuse, substance abuse, poor health self-management, psychiatric admission, homelessness, violence, cognitive difficulties, mobility problems, sensory impairment, and chronic physical illness (Lightbody et al., 2010; Di Lorito et al. 2018). This means they have complex needs and risks. The remit of forensic psychiatric services is to respond to patients individual treatment needs to enable recovery and better levels of health, wellbeing and quality of life and lower levels of risk to themselves and others (Anderson, 2011). The ability of services to meet these needs requires further investigation (O Sullivan & Chesterman, 2007; Coid et al. 2011). When compared to younger adults forensic inpatients, older adults did not show improvements at discharge on measures of severe disturbance, emotional well-being, or risk; and they experience a decline in personal wellbeing (Griffiths, 2018) - despite longer periods of hospitalisation (Völlm et al., 2017). It is important that psychiatric services fit individual needs to enable progression, recovery and better levels of health, wellbeing and quality of life (Anderson, 2011). Unmet needs mean some patients remain in a higher level of security than is appropriate for their risk level (Yorston, 1999). Research is required to understand patient needs and to enable services meet these needs. The overall aim is make recommendations with the goal of enhancing patient recovery and wellbeing and reducing risks. Objectives are to: 1) understand the wellbeing, quality of life, and health recovery needs of older forensic patients in secure and community settings; 2) identify patient and professional perspectives regarding the barriers and facilitators to recovery, wellbeing, health and progress along the care pathway; 3) produce recommendations for best practice for working with this population; which can contribute to national standards, service development, and the design of interventions. To understand needs, and barriers and facilitators to progress, in-depth interviews with patients and staff working with them will be undertaken. Enabling the voice of both patients and staff. Using self-report measures this project will also gain patient wellbeing, health, cognitive functioning, and recovery levels. A project advisory group will include older adults with experience of mental illness and the criminal justice system to gain their perspective in project set-up, delivery, and reporting results; and are involved in designing project materials, interpreting qualitative data, and dissemination. Dissemination will be carried out through professional networks, social media, input into guidance and standards documentation, conference presentations, and academic, lay, and professional publications.

Background and Objectives Among the various psychosocial interventions aiming at improving behavior, quality of life, and the well-being of people with dementia, one that has attracted recent attention has been object handling. This scoping review synthesizes available studies on object handling for people with dementia, their effects, and methodological characteristics and describes its components and likely domains. Research Design and Methods The search was conducted using CINAHL, PsycINFO, MEDLINE, PsycARTICLES, Academic Search Elite, and Art Full Text, plus review of reference lists and hand search. Data from the studies included were chattered and reported in narrative form. Results Eleven studies were included; of which, 9 described a group intervention and 10 investigated the distinctive value of heritage items. Studies used a mixed-methods or qualitative design and varied in their procedures, including number of sessions and length of intervention. Most studies reported positive effects on well-being, mood, and emotion in those with dementia. Qualitative investigations revealed that the co-construction of an object’s meaning facilitated new learning, social inclusion, and change in attitudes toward dementia. From the review and stakeholder consultations, a definition of object handling is proposed, which includes three components: presenting, receiving, and responding. Discussion and Implications The findings suggest that people with dementia may benefit from object handling interventions as a means of improving well-being, mood, and social inclusion. The review highlighted a variety of approaches used and a small number of studies were identified under the term of “object handling.” Further studies are needed to examine the complexity of object handling, its impact within dementia care settings, and that explicitly use the term “object handling.” Given the focus to date on heritage, archive, and museum objects, more studies involving the handling of everyday material objects are needed because these are by definition highly accessible.

Background and Objectives Among the various psychosocial interventions aiming at improving behavior, quality of life, and the well-being of people with dementia, one that has attracted recent attention has been object handling. This scoping review synthesizes available studies on object handling for people with dementia, their effects, and methodological characteristics and describes its components and likely domains. Research Design and Methods The search was conducted using CINAHL, PsycINFO, MEDLINE, PsycARTICLES, Academic Search Elite, and Art Full Text, plus review of reference lists and hand search. Data from the studies included were chattered and reported in narrative form. Results Eleven studies were included; of which, 9 described a group intervention and 10 investigated the distinctive value of heritage items. Studies used a mixed-methods or qualitative design and varied in their procedures, including number of sessions and length of intervention. Most studies reported positive effects on well-being, mood, and emotion in those with dementia. Qualitative investigations revealed that the co-construction of an object’s meaning facilitated new learning, social inclusion, and change in attitudes toward dementia. From the review and stakeholder consultations, a definition of object handling is proposed, which includes three components: presenting, receiving, and responding. Discussion and Implications The findings suggest that people with dementia may benefit from object handling interventions as a means of improving well-being, mood, and social inclusion. The review highlighted a variety of approaches used and a small number of studies were identified under the term of “object handling.” Further studies are needed to examine the complexity of object handling, its impact within dementia care settings, and that explicitly use the term “object handling.” Given the focus to date on heritage, archive, and museum objects, more studies involving the handling of everyday material objects are needed because these are by definition highly accessible.

Older forensic mental health patients have complex needs and requirements; service provision is required to address mental health, offending risk and issues associated with aging (geriatric care). This study aimed to identify the systems and processes that enable valued progress (in terms of quality of life, health, wellbeing, recovery and reduced risk) for older forensic mental health patients. Interviews were conducted with 48 members of staff working with these patients in secure hospitals or the community. Thematic analysis was used to analyze the data. Four overarching themes were identified regarding what facilitated or acted as a barrier in relation to quality of life, health, wellbeing and recovery. Multidisciplinary input, an individualized approach and implementing holistic and needs-led care was found to facilitate progress. However, lack of resources, excluding the patients in care planning, gaps in expertise and knowledge, and a lack of specialized units that could address mental health, forensic and elderly needs were found to be barriers. Extensive, multilevel and wide-ranging support is required specifically for older forensic mental health patients. Joint working is required between older adult and forensic mental health services incorporating geriatric medicine expertise in order to implement co-produced care and treatment plans.

Objectives: There is a lack of research informing service delivery for older forensic mental health patients. This study explored service provision in forensic mental health inpatient and community services in England, investigating what is required for progress in terms of quality of life, health, wellbeing, recovery and reduced risk, and the barriers and facilitators associated with this. Methods: Semi-structured interviews were undertaken with 48 members of staff working with older forensic mental health patients in secure inpatient units or the community in England. Data were analysed using thematic analysis. Results: Two global themes ‘What works’ and ‘What doesn’t work’ were identified comprising themes representing environmental, interpersonal and individual factors. ‘What works’ included: positive social support and relationships; individualised holistic patient-centred care; hub and spoke approach to patient care; and suitable environments. ‘What doesn’t work’ included: absence of/or maladaptive relationships with family and friends; gaps in service provision; and unsuitable environments. Conclusions: For older patients to progress to improved quality of life, health, wellbeing and reduced risk, multilevel and comprehensive support is required, comprising a range of services, interventions, and multidisciplinary input, and individualised to each patient’s needs. The physical environment needs to be adapted for older patients and provide a social environment that seeks to include supportive families, friends and expert professional input. A clear patient progression pathway is required; this must be reflected in policy and provision.