Experiences of family caregivers in forensic mental health care: A qualitative evidence synthesis

INTRODUCTION: There is a lack of research about experiences of family caregivers of service users in forensic mental health care (FMHC) and their involvement in care and treatment. Research shows that caregivers are burdened. Further knowledge is required, to provide a foundation for improving clinical practice.

AIM: To review research literature, to investigate existing knowledge about caregiver experiences and, secondly, caregivers' experiences of facilitators and barriers related to their involvement in care and treatment.

METHOD: Qualitative evidence synthesis undertaken in a thematic synthesis of thirteen peer-reviewed studies.

RESULTS: The analysis identified three descriptive themes: violence against family; a great burden of responsibility; and difficult collaboration, together with an additional three analytical themes: bearing witness; persistent presence; and advocacy becomes necessary.

DISCUSSION: Persistent caregiver presence and/or caregiver advocacy may be elicited by health care professionals' (HCPs') exclusion of caregivers from care and treatment. Caregivers' feelings of guilt in relation to the service user's offence may play an additional role in persistent presence and advocacy and therefore in HCPs' exclusion of them.

IMPLICATIONS FOR PRACTICE: HCPs need to develop their collaboration with caregivers by their willingness to listen to caregivers to understand emotional complexities within families experiencing mental illness and offence.

RELEVANCE STATEMENT: Family caregivers of service users in forensic mental health care are burdened by the service user's mental state, offence(s) and difficult collaboration with health care professionals, including nurses. Research about caregiver experiences, as well as facilitators and barriers regarding their involvement in the care and treatment of the service user, is needed for caregivers to maintain their support of the service user.