Bridging the gap : exploring recovery and transition from secure forensic mental health care to the community

Lavery, Chloe and Klein, Maike (2025) Bridging the gap : exploring recovery and transition from secure forensic mental health care to the community. PhD thesis, Lancaster University.

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Abstract

This thesis comprises three chapters, exploring recovery and transition from secure forensic mental health (FMH) care to the community. Chapter one presents a mixed-method systematic literature review of thirteen papers on the factors influencing transition to the community from secure FMH care. The review highlighted four key themes related to compliance, adjustment, experience of support and substance use in relation to transition from secure care to the community. Learning from both quantitative and qualitative research demonstrates the importance of factors such as unhelpful coping and mental health, as well as social context. The review highlighted a gap in research in relation to considering what helps transition from secure care to the community, with existing research tending to focus on recall or readmission to hospital. Chapter two sought to address this gap in knowledge by employing a constructivist grounded theory approach to develop a conceptual understanding of the transition process from secure FMH care into the community, from the perspectives of ten individuals with lived experience of this, alongside problematic substance use (PSU). Findings highlight how the interplay between an individual’s personal and systemic factors can both facilitate and hinder their recovery and ability to progress towards discharge. Additionally, findings show that identity development and empowerment of those transitioning are underpinned by internal and external factors such as adjustment to hospital, gradual independence and connectedness and safety in the community. Chapter three presents a critical appraisal of chapters one and two, elaborating on the thesis’ strengths, limitations and areas for future research. It also presents further insight into clinical implications of the findings and provides personal reflections on the research process as a whole, including design stages and reflexivity during analysis.